More Possible Benefits of Ohio Health Insurance Plans

Possible additional benefits in Ohio plans

Ohio law guarantees certain benefits. However your health plan may cover extra benefits. Therefore, there is a lot of variation.

Prescription drug coverage

Ohio law does not require health plans to cover prescription drugs. Plans that do provide this coverage can exclude a specific drug or a specific class of drugs (example: birth control pills). If your health plan covers prescriptions, it may have a formulary -- a list of the drugs it will pay for.

It may be possible for you to get a drug that's not on the plan formulary if your doctor certifies the formulary drug will not treat your condition effectively or that it could cause a bad reaction.

Mental health coverage

All health plans in Ohio must provide coverage for the diagnosis and treatment of biologically-based mental illness. Care must be provided on the same terms and conditions as that of all other physical disorders, except in limited circumstances.

A plan must also provide prescription drug coverage for biologically-based mental illness if prescription drugs are covered for physical illness. benefits must have the same copays, deductibles and cost sharing requirements for physical illnesses.

Employers and insurers may negotiate rates of reimbursement and may establish provider networks to deliver mental health services to their insureds.

Well-child coverage

HMOs cover well-child care for all children. Traditional plans that offer family coverage must help pay for certain routine benefits for children, such as complete physical exams, developmental assessments, anticipatory guidance, lab tests and immunizations from birth through age eight. Plans are not required to pay more than $500 in benefits the first year, and no more than $150 each year from age one through age eight. As of age nine, this coverage is not required.

Mentally impaired or handicapped child coverage

Group policies for family members normally stop covering children who have reached the range of 19 to 23 years old. But if your child is mentally or physically impaired the coverage must be continued for as long as the child must depend on you for maintenance and support.

For a list of authorized companies visit www.ohioinsurance.gov or call Consumer Services at 1-800-686-1526.