Ohio Open Enrollment
Ohio law requires us to accept a certain number of individuals for open enrollment coverage without regard to health status. If you qualify as a Federally Eligible Individual (FEI), your coverage will be effective immediately without any pre-existing condition exclusion period. If you do not qualify as a FEI, you may apply for FEI open enrollment coverage.
You are a Federally Eligible Individual if you meet all of the following conditions-
- You had health coverage for at least 18 months without a break in coverage greater than 63 days.
- Your most recent health coverage was under a group health plan, governmental plan, or church plan.
- You are not eligible for coverage under any of the following plans:
- Group plan
- Medicare
- Medicaid
- You do not have any other health coverage.
- Your most recent health coverage was not terminated because of nonpayment of premiums or fraud.
- If you had been offered the option to continue coverage under COBRA or a state continuation plan, you both elected and exhausted the continuation coverage.
If we have not yet met our enrollment quota, we will offer you the Ohio health care Basic or Standard benefit plans for purchase. You may need to submit proof of previous creditable coverage.
You are a Non-Federally Eligible Individual if you meet the following conditions-
- You are not applying for coverage as an employee of and employer, member of an association or member of any other group.
- You do not have any other health coverage and are not eligible to be covered under any private or public health benefit plans including the following:
- Medicare or Medicare Supplement policy
- Medicaid
- Any Cobra or state continuation coverage plan
- Other health benefits arrangement
If we have not yet met our enrollment quota, we will offer you the Ohio health care Basic and Standard benefit plans for purchase. We are not required to accept applicants who at the time of enrollment, are confined to a health care facility due to chronic illness or permanent injury. As a Non-Federally Eligible Individual coverage may be limited for pre-existing conditions for the first 12 months; however, we will credit time you were covered under a recent previous health plan.
Basic and Standard benefit plans we offer:
Benefit | H31 - Ohio
Basic Plan | H32 - Ohio
Standard Plan |
Calendar Year Deductible | $1,000 | $750 |
Family Limit on Deductible | None | None |
Emergency Room Deductible(1) | $75 | $75 |
Coinsurance | 50/50 | 70/30 |
Individual Out of Pocket(2) | $5,000 | $5,000 |
Family Out-of-Pocket | None | None |
Maternity and Routine Nursery Care Benefits(3) | None | $3,000 |
Calendar Year Maximum(4) | $50,000 | N/A |
Lifetime Maximum(4) | N/A | $1,000,000 |
- Emergency Room Deductible is waived if admitted to the hospital. This deductible is in addition to the Calendar Year Deductible.
- In addition to the Calendar Year Deductible
- Basic plan routine nursery care benefits for a normal delivery are limited to $3,000 per occurence. Complications in all plans are paid same as any other illness.
- Per insured maximum.
H31 Basic Plan Rates • H32 Standard Plan Rates
Ohio Open Enrollement Application – LA149 OH
If you have any questions or would like to request an application, email or contact Bert Wasson at 800-322-0120, Extension 2536.