Advocacy Alert: October

Insurance Info: Pre-existing Conditions

By: Bobbie L. Celeste, PhD, OPA Director of Professional Affairs

Protections for children with pre-existing conditions went into effect on September 23, 2010. Based on the Affordable Care Act (“Obamacare”), insurers are not permitted to deny coverage to children due to their health status, or exclude coverage for pre-existing conditions. Adults will be given similar protection, beginning in January, 2014. Until then, clients with pre-existing conditions may qualify for health insurance through Ohio’s high-risk pool. Several mental health diagnosis are mentioned in the list of pre-existing conditions (bi-polar disorder, drug addiction, schizophrenia) and others may be covered as well. The application date for new or renewing applicants is January 1, 2013, so now is the time to help your clients gather their documentation.

To qualify you must be a U.S. citizen and resident of Ohio; have been turned down by two insurers or have a letter from a physician; and have been uninsured for the previous 6 months. Individuals must also send along the first month’s insurance payment with their application. Rates vary depending on ones age, county, and smoking status. E.g. A 21 year old non-smoker from Montgomery County would pay $146 per month for a $1,500 deductible plan. A smoker, over 60 who lives in Cuyahoga County might pay as high as $642 per month. A $2,500 deductible plan is also available, for slightly less per month. For more information, visit ohiohighriskpool.com. Also, for more information about the Affordable Care Act and pre-existing conditions, visit this website. If you have clients who are uninsured or low income who need access to health care, they can try the UCHAN Ohio Helpline at : (614) 456-0060 ext 233, or send an email. If you are an OPA member and you need help getting paid by insurers or have questions about mental health parity, please contact Bobbie Celeste, PhD, OPA’s Director of Professional Affairs.

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