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The Ohio Department of Aging

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CONNECT TO | Policy & Legislation
September 2010
 

Health insurance available for high-risk uninsured
Ohio residents with chronic medical problems now have another option

People with pre-existing medical conditions can apply for health insurance through Ohio's High Risk Pool, which gives uninsured Ohioans with pre-existing conditions access to quality health insurance. The program is being administered by Medical Mutual of Ohio, one of the state's largest health insurers.

Ohio's High Risk Pool

Unlike typical insurance plans, applicants for the new program cannot be charged higher premiums or denied coverage because of their medical problems or the medications they take.

The program was created to provide temporary relief until sweeping changes included in the recently enacted federal health reform are fully effective in 2014. The federal government is providing $152 million to help pay the medical bills for enrollees in the Ohio High Risk Pool from now until 2014.

The federal funds, along with monthly premiums participants will pay, are enough to cover the costs for an estimated 5,500 enrollees. Monthly premiums will range from $92 to $777, depending on age, coverage selected, where people live and whether they smoke. An estimated 1.3 million Ohio residents are uninsured, but not all will qualify for the program.

To be eligible, participants must:

  • Be uninsured for six months prior to the coverage application date;
  • Be a U.S. citizen and an Ohio resident;
  • Not be eligible for other government programs (such as Medicare or Medicaid) or coverage through their employer, unless there is a mandatory initial waiting period; and
  • Have a qualifying pre-existing condition, such as asthma, chronic obstructive pulmonary disease, chronic pain diseases, coronary artery disease, depression, diabetes, heart failure or pregnancy.

In addition, during the application process participants will have to supply:

  • Proof of U.S. citizenship, such as a birth certificate, passport, certificate of citizenship, naturalization certificate, visa or immigration documents;
  • Proof of Ohio residency, such as an Ohio driver's license or state identification card, payroll stub, voter registration card, utility bills, a rental agreement or Ohio income tax return;
  • Evidence of a pre-existing condition, which can be either documents from two carriers, verifying each has refused to issue creditable coverage to you within the previous six months or would issue coverage only with an exclusionary rider, OR written certification by a licensed health care professional, issued within the past six months, certifying that you have a history of, or suffer from, a qualifying medical or health condition; and
  • First month's contribution payment, which can be either a check or money order, made payable to Medical Mutual of Ohio.

Coverage begins the first day of the following month for applications submitted by the 15th of each month.

There are two plans available: One with a $1,500 deductible before coverage begins and a maximum co-insurance out-of-pocket amount of $3,000 for in-network services, and a less expensive option with a $2,500 deductible and $4,900 out-of-pocket maximum.

Enrollees in both plans can pay the least out-of-pocket charges by going to a contracted doctor or hospital in Medical Mutual's SuperMed network. Even while enrollees are meeting their deductible, they'll pay the discounted rates negotiated by Medical Mutual for services, not the higher billed prices.

Plan designs, monthly rates, applications, physician certification form and a checklist can be found at OhioHighRiskPool.com or by calling customer service at 1-877-730-1117.

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