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Ohio High Risk Health Insurance Pool

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As part of the health care reform bill passed by Congress and signed into law by President Obama in March, new high risk health insurance pools will be created by several states. The pools are designed to last 40 months and bridge the gap until applicants with preexisting conditions must be underwritten for permanent coverage.
(Editor’s note: There is no longer a high risk pool needed or offered.)

The Department of Health and Human Services is working closely with individual states in order to provide program regulations and specifications. Ohio is one such state that has chosen to create their own pool as oppose to joining the federal program.

Medical Mutual of Ohio

Medical Mutual was chosen by the Ohio Department of Insurance to setup and operate the high risk pool.   Applications will be accepted as of August 1st and coverage can begin on September 1, 2010 at the earliest. Two plans will be offered; one with a $1,500 and the other a $2,500 deductible. Age, gender and tobacco use will affect monthly rates for the applicant.

The state of Ohio is expected to receive approximately $152 million from the federal government to administer the pool. Once that money has been spent, it is unlikely that any new funding would be appropriated for coverage expenses.

Visit http://www.ohiohighriskpool.com/  for more information.

Admission Requirements for Ohio’s High Risk Pool

There are several requirements that must be met before consumers can gain access to the pool. Individuals will need to provide proof of the following:

  • Must be  uninsured for six months
  • Can have no access to employer sponsored health insurance
  • Been denied coverage from two separate insurers
  • Ineligible for Medicare and/or Medicaid and other state run programs
  • Afflicted by a generally accepted preexisting condition
  • Citizen of the United States
  • Resident of the state of Ohio

Proof of the above listed requirements may be required in most cases. Consumers may need two letters of declination, a letter from a medical professional detailing their preexisting condition(s), and acceptable forms of state and or federal identification.

The Health Insurance Agent’s Role

In Ohio, Medical Mutual will not be compensating agents who assist with entry to the high risk health insurance pool.  In this way, applicants  may be working directly with the carrier.  However agents can provide some assistance with letters of declination from insurance companies. Even if a consumer has been without coverage for six months, he or she will still need two letters of denial.

There are some health insurance providers that simply underwrite to a yes/no standard. On the other hand, some carriers might provide coverage, but rider out preexisting conditions. If an individual desires access to Medical Mutual’s plan, then they will want to make application to two companies that are more likely to decline coverage than to rider out a condition.

When it comes to traditional health insurance in Ohio, both Anthem Blue Cross Blue Shield and Aetna are more likely to decline coverage whereas Assurant, Medical Mutual and United Healthcare may provide limited coverage. If an individual is in need of two letters, then they may want to make application or speak with Anthem and Aetna first.

Individual and Family Health Insurance

Hyers and Associates, Inc. is an independent agency providing medical insurance in Ohio and beyond. Should you need coverage outside of the high risk pool, then we can help you.

In some cases, only one family member will be eligible for state run coverage. We can help the other family members gain entry into a traditional or HSA medical insurance plan with any of our well known carriers. Contact us today for more information.

Category: Health Care Reform, Health Insurance