Newly Released Federal Requirements to Change Ohio Health Insurance Scene

The U.S. Department of Health and Human Services (HHS) has just released rules to implement the provisions of the health care law to reduce discrimination against people with pre-existing conditions, help consumers compare their coverage options, and allow the implementation of equitable workplace wellness programs. These proposed rules, to take effect in January 2014, will change the Ohio health insurance scene in many ways.

• Universal coverage: Up to 32 million Americans, including about 1.5 million uninsured Ohioans, will now have the chance to gain coverage. The new regulations will extend the health care safety net for the low income population as well as those who were deemed too sick to be provided coverage by insurers. People with pre-existing conditions can no longer be denied health insurance and can access catastrophic coverage in the individual market.

• Fairer health insurance premiums, but rise in costs for younger persons: Insurers can no longer charge higher premiums based on factors such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry. Ohio health insurance companies are allowed to vary premiums only based on age, tobacco use (the rate cannot vary by more than 1.5 to 1), family size, and geography.

Previously, many plans charged women from 30-85 percent more than men for the same coverage. This will no longer be possible - women will not have to pay higher premiums than men for a specific issue.

Smokers would have to pay a higher premium – even twice as high as non-smokers. Exemptions will be offered for smokers trying to break the habit.

The rates of health insurance OH can vary based on a person’s age but no more than a 3:1 ratio. This means that an adult can be charged only three times more than what a younger person is charged. So younger Ohioans will experience rising monthly premiums as they pay more to cover the cost of providing health care for older people.

• States offered flexibility for Essential Health Benefits: All the states have been informed of the requirements of outlining policies and standards for coverage of essential health benefits (EHB). Ohio health plans are expected to cover a core package of items and services, but the state will have the flexibility to decide how EHB are defined. Ohio will have to choose a benchmark plan and ensure that plans offering EHB adhere to the benefits offered by the benchmark plan.

• Promotion of employer wellness programs: Another newly released proposal allows employers to offer discounts on insurance premiums to employees enrolling in job-based wellness programs. Under these programs, employees can benefit from reimbursement for the cost of membership in a fitness center, and rewards for attending a monthly, no-cost health education seminar or completing a health risk assessment. Employer will have to offer other options for employees who have a physical condition that makes it “unreasonably difficult” for them to participate.

Employees who do not join a wellness program could end up paying a penalty, while smokers would receive a 50 percent discount for breaking the habit.

Uninsured individuals and families, and employers looking for Ohio group health insurance, can get professional guidance to purchase affordable coverage. An experienced, licensed Ohio-based health insurance broker can provide all the support necessary to choose the right Ohio health insurance plan.