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What are the requirements for Ohio health insurance?

woman holding question mark looking for Ohio health insuranceRequirements for health insurance in Ohio vary depending on a person’s age, income, and family status. There are many program options for residents of Ohio. State agencies such as the Ohio State Department of Insuranceare helpful with explaining requirements specific to this state.

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There are numerous private health insurance providers licensed in the state of Ohio. Among the major companies offering comprehensive health coverage are Anthem Blue Cross and Blue Shield, and the Kaiser Permanente Group. Many other companies feature competitive rates and comparable programs. Requirements for coverage vary from group to group.

Ohio also administers the federally mandated Medicare program for adults over 65, and the Medicaid program for those with lower incomes, who qualify under state guidelines.

Are there special health services for Native Americans?

Yes! The Indian Health Service is a federally funded program designed to serve the needs of both Native Americans and Alaskan natives by providing them with information and access to medical services.

Many programs are available through the IHS including, health discipline, medical specialties such as maternity, public health and wellness and other medical support services. The IHS website has a full A- Z listing of resources available to native groups in all 50 states.

What changes have taken place in health care legislation in Ohio?

According the Ohio Department of Insurance, recent changes in Ohio laws have been implemented to reduce the number of uninsured individuals in the state. Laws have also been enacted that favor small business owners, allowing more businesses to offer their employees health insurance benefits. Major provisions of these laws include:

  • Rate caps for individuals with pre-existing conditions
  • Increasing the age of coverage for qualified dependents to 28
  • Requiring businesses to allow employees to purchase insurance with pre-tax money
  • The extension of Ohio’s “mini-COBRA” program to cover more employees of small businesses

What is COBRA?

COBRAis a program created by the federal government that gives employees who become unemployed, the opportunity to temporarily continue their health insurance coverage at group rates. The COBRA laws apply to all businesses that employ more than 20 people.

Mini-COBRA, in states such as Ohio, supplements the federal law and applies to small businesses with fewer than 20 employees. Coverage under this program originally could be maintained for up to six months.

Federal stimulus legislation enacted in 2010 provides some financial relief for certain cash-strapped Ohioans in the form of health insurance subsidies. Following these changes, Mini-COBRA coverage was extended to 12 months for residents of Ohio.

More recently, temporary extensions of continuation coverage through Mini-COBRA have been increased again, from 12 to 15 months, allowing individual Ohio residents to take full advantage of their state or federal health insurance subsidies.

What is the HCTC credit?

Certain Ohioans may also qualify for the federal Health Coverage Tax Credit. This credit amounts to a full 80% of qualified health insurance premiums. The credit may be claimed when filing a tax return and is used to offset income taxes or refunded to the taxpayer. It may even be paid out in advance, with monthly installments, by agreement with the IRS.

Who is eligible for the HCTC credit?

Ohioans receiving funds from the following programs are eligible for the HCTC credit under the state:

  • Trade Readjustment Allowance
  • TRA, the Trade Assistance Act, TAA
  • Reemployment Trade Adjustment Assistance, RTAA

Those who would be eligible for TRA benefits, but are still able to collect unemployment benefits, are also eligible to claim the HCTC credit.

Qualified health insurance providers include:

  • Anthem Blue Cross and Blue Shield
  • Kaiser Permanente in Northeastern Ohio
  • COBRA
  • Spousal coverage

What if I’ve been denied health coverage in Ohio?

Ohio law provides recourse for those who have been denied coverage or may have had their insurance coverage limited or terminated. The law outlines an appeal process, which applies to most any public insurance, HMO or PPO type plan.

The appeal process includes an appeal to the insurance company itself. If unresolved, the case then goes to the Ohio Attorney General’s office.

An external group or independent review organization, IRO, may then review certain cases. The external review may find in the claimant’s favor or deny the appeal, which still leaves the claimant the option to file a civil lawsuit.

Finding affordable health insurance coverage to fill your family’s medical needs is an important and necessary task. Consumers should investigate all available options and compare benefit packages before making a final selection.

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