Ohio Department of Insurance Guide

The Ohio Department of Insurance has created this guide to help you understand some of the basics of health insurance. This guide is intended to help individuals, families, self-employed people and small business owners evaluate their options.

If you have health coverage, try to keep it. Unless the policy owner (you or your employer) stops paying premiums, the health plan cannot cancel your coverage -- even if you get sick. The law allows you to keep coverage through life-changing events (divorce, changing jobs, job loss, etc.) Not having health insurance can be a dangerous decision. If you're not covered and have an accident or develop a serious illness, it can be financially devastating.

What is health insurance?

Health insurance is a general term used to describe many kinds of insurance coverage. For most people, the term "health insurance" means comprehensive health insurance. This is the broadest kind of health insurance and covers most of the cost of keeping you healthy and getting you healthy if you become ill. Comprehensive health insurance includes doctor visits, hospital care, tests, certain therapies and sometimes prescription drugs. Medicare and Medicaid provide such comprehensive coverage to eligible people.

Types of comprehensive health insurance plans

Comprehensive health insurance plans can be offered by employers or on an individual basis through a variety of insurance companies. Coverage can be in the form of managed care or traditional health insurance.

Managed care

Managed care is a type of health delivery system that includes participating providers who contract with the health plan. The providers manage the care of their patients. Types of managed care plans include HMOs (called health insuring companies -- HICs -- in Ohio), PPOs and POS plans. Some managed care plans require you to have a Primary Care Physician (PCP). If so, you must rely on your PCP anytime you need a service.

When appropriate, the PCP will refer you to a specialist within the plan's network. The plan may allow you direct access to the specialist depending on the seriousness of your condition or if you require specialized care over a long period of time.