Medical Mutual Of Ohio has been selected by the Ohio Department Of Insurance to administer and manage the “High Risk Pool.” They will manage claims, handle the application process and provide customer service support. The Federal government has provided $152 million to subsidize costs that exceed premium payments collected by new enrollees. It is possible that there will be a waiting list if enrollment limits are met. A separate “Open Enrollment” option is also offered but rates are higher.
You should NOT apply for High Risk Pool coverage unless you have major health conditions. Since prices are significantly higher than standard rates, an underwritten contract is a better option if there are no ongoing medical issues.
The Ohio Risk Pool and Medical Mutual of Ohio, provide affordable healthcare to Buckeye State residents that have major pre-existing conditions and that have previously been denied coverage. The two available plans have no annual or lifetime limits and no exclusions. Also, out-of-pocket costs will be limited to comply with recent national healthcare reform.
Qualifications
To qualify for the Ohio High Risk Pool, some of the eligibility requirements include:
- Ohio resident at the time you apply for coverage
- Be without coverage for six months
- Have a qualifying pre-existing condition
- Not be eligible for coverage for Medicare, the Ohio Medical Assistance program, CHIP program or individual/group coverage.
- Be a citizen of the US and also reside in the United States.
Plan Details
Two lpans are available with either a $1,500 deductible or a $2,500 deductible. Each plan includes prescription drug benefits, health and wellness coverage, office visit and prescription benefits, maternity services and emergency service protection. Network coverage is provided by Medical Mutual’s SuperMed Network, one of the largest groups of providers in the state. Whether you live in the Northern part of the state (Akron, Cleveland, Canton) or closer to Dayton and Cincinnati, many physicians, specialists, and hospitals are located within your service area.
Many preventive benefits are covered at 100%. Some of these coverages include routine medical exams, well child care exams, routine mammograms and pap tests and standard immunizations. Additional benefits include mental health and substance abuse coverage, home health care and maternity services. However, many non-preventive items are subject to a deductible.
Once a policy is approved, coverage will begin on the first of one of the following two months. The effective date depends upon when the application was received. Billing can be monthly, and at any time, a policyholder can cancel coverage. When applying for coverage, a check or money order must be submitted for the first monthly premium, along with the completed application.
If you do not have major health conditions, then you should NOT attempt to apply for this type of coverage. Instead, you should provide your zip code at the top of the page and compare the best available plans in your area.
