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Health Care
The following agencies/organizations provide information about health care.
Ohio
- Children's Buy-In Program
- Guide to Finding Health Coverage (PDF file)
- Healthcare Reform Initiatives
- Ohio Department of Insurance
- Pre-Existing Condition Insurance Plan: Ohio
- Universal Health Care Action Network of Ohio (UHCAN)
National
- A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan
- Agency for Healthcare Research and Quality - Questions and Answers About Health Insurance
- America's Health Insurance Plans
- Center for Studying Health System Change
- CLASS: The Community Living Assistance Services and Support Program
- Disability.gov - Health Insurance
- elaws - Health Benefits Advisor
- Fact Sheet: The Affordable Care Act's New Patient's Bill of Rights
- FamiliesUSA - Health Reform Central
- Foundation for Health Coverage Education
- Health Care Reform and Family Caregivers (PDF file)
- Health Care Reform and the CLASS Act
- Health Information and the Law
- HealthCare.gov
- Healthy Access Database
- Impact of Health Care Reform on People with Disabilities
- Insure U
- Kaiser Family Foundation
- Medicaid Long-Term Services and Supports: Key Changes in the Health Reform Law
- Medicare and the New Health Law - What it Means for You (PDF file)
- Pre-existing Condition Insurance Plan
- statehealthfacts.org
- The Affordable Care Act and Children with Special Health Care Needs (PDF file)
- The Caregivers Marketplace (cash reimbursement program for eligible items that are not covered by insurance or Medicaid)
- UnitedHealthcare Children's Foundation Inc. (grants for medical costs)
- Young and Invincibles
- Your Medical Bills: A Consumer's Guide to Coping with Medical Debt
Prescription Coverage
If you do not have insurance that includes prescription coverage, there are programs that may be able to help cover prescription costs.
Ohio
National
- Access to Benefits Coalition
- Medicare - Pharmaceutical Assistance Program
- NeedyMeds.com
- NORD's Medication Assistance Programs
- Partnership for Prescription Assistance
- Patient Advocate Foundation Co-Pay Relief Program
- Prescription Hope
- Rx Outreach
- RxAssist
- RxHope
- SelectCare Benefits Network
- The Medicine Program
- Together Rx Access
Insurance: Your Rights
The laws of Ohio and of the United States prohibit discrimination based on disability in housing, employment and in other areas. What about health insurance? Unfortunately, Americans with disabilities are more likely than people without disabilities to be denied insurance coverage, and insurance laws provide limited rights protections for people with disabilities. But you do have rights.
Limited Rights Under the Laws
As in hiring, firing and promotion, federal and state laws prohibit disability-based discrimination by employers when they provide company fringe benefits, such as health insurance coverage. However, the Americans with Disabilities Act Title I (Employment) may allow employers to deny health insurance based on disability, if the employer can justify denial by insurance statistics and "actual substantial increase" in costs.
Insurance companies may also deny health insurance. Under some circumstances the ADA Title III (Public Accommodations) does not regulate insurance companies when individuals apply to the companies for insurance directly.
Although rights protections for people with disabilities are limited, you do have rights if you are refused an insurance policy, or if you are denied a particular claim under an existing policy. These rights are explained in your copy of the insurance policy.
Time is usually very limited in insurance disputes. If you believe you have been wrongly refused a policy or denied a particular claim under your policy, Ohio Legal Rights Service strongly recommends that you respond as soon as possible.
Internal (Provider) Complaints
Most insurance complaints must first be presented to, and decided by, a neutral office of the insurance provider itself. Insurance policies define the internal complaint procedures and strict deadlines to file complaints. Time may be very short. If you miss a deadline, you may lose your right to file any complaint.
External (Agency) Complaints
The insurance industry is regulated by several federal and state agencies, which generally receive complaints only after the insurance provider's internal complaint procedure is finished. These federal and state agencies represent neither you nor the insurance provider. For example, the stated mission of the Ohio Department of Insurance is "to be responsive to and safeguard consumer interests ... while promoting a stable and competitive marketplace among insurance providers." The agency to receive your complaint depends upon the source of the policy:
- Individual Policies - You buy from insurance provider.
- Employers' Group Plans - Employer buys from insurance provider.
- Employers' Self-Insured Plans - Employer operates its own plan.
Individual and Group Plans
The Ohio Department of Insurance (ODI) receives complaints about most individual policies and employers' group plans. Some complaints may be filed on-line. Legal Rights Service (LRS) recommends that you contact ODI as soon as possible to learn about your rights given your particular policy and your particular complaint.
Employer's Self-Insured Plans
The U.S. Department of Labor (DOL) receives complaints about these plans under ERISA (Employee Retirement Income Security Act). Contact DOL's ERISA enforcement division as soon as possible to learn about your rights.
You also have the right to file a lawsuit under ERISA after complaint procedures are finished. Consult a lawyer in private practice as soon as possible.
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