Pre-existing Conditions
Health Insurance Alternatives for Ohio Residents
Do Ohio residents have insurance options when they've been denied health insurance coverage due to a pre-existing condition? Yes they do.
Many states have an assigned risk health insurance pool whereby individuals may obtain health insurance coverage when private insurance carriers have denied them coverage due to a pre-existing condition. Residents in the state of Ohio do not have such an option. Without a state mandated assigned risk plan, what's an Ohio resident with pre-existing conditions to do?
Prior Insurance through an Employer
If an Ohio resident was previously insured through a health insurance plan with an employer, and has opted to purchase the COBRA coverage, they have the option of obtaining coverage through Ohio's Health Insurance Portability and Accountability Act (HIPPA).
To be eligible for HIPPA, the individual must be considered a Federally Eligible Individual (FEI), which means meeting the following requirements:
- 18 months of health coverage and the coverage was through an employer
- Have exhausted all of the COBRA benefits
- Coverage was not cancelled as a result of non payment of premium
- Ineligible for Medicare, Medicaid or other coverage
For immediate coverage, the individual must enroll in the health plan by the 63rd day after the old coverage expires. By doing so, the insurer cannot institute a pre-existing condition exclusion waiting period. Therefore, the individual will have coverage for the pre-existing condition.
If the individual does not satisfy the above requirements and is not considered a Federally Eligible Individual, then the insurance company can apply a 90-day waiting period for coverage and a 12-month exclusionary waiting period for pre-existing conditions.
No Prior Insurance
For individuals who have pre-existing conditions and were not previously covered through an employee plan, they must secure individual health care coverage through the Annual Open Enrollment periods.
In essence, during the period of open enrollment, the insurance carriers providing HMO insurance may not deny coverage to individuals due to a pre-existing condition. Individuals who contact the insurance companies during the open enrollment period may obtain health insurance coverage (including coverage for the pre-existing condition).
There are a few stipulations that the individual should keep in mind:
- The individual must live within the HMO's service area
- Coverage may not be immediate as it is with HIPPA. Coverage may not begin until 90 days after enrollment.
- HMO's may limit their open enrollment period.
Be forewarned however; individuals approaching the same HMO insurance carriers at any time other than the annual open enrollment may be denied coverage, especially if the individual has a pre-existing condition.
Additional Information
For information on HIPPA and Annual Open Enrollment plans, contact the Ohio Department of Insurance.
Individuals with questions regarding pre-existing conditions, visit the Blogging About Insurance blog.
