Notify the Benefits department on and Enrollment/Change form of the following changes within 31 days of the event:
Loss of medical or dental coverage due to:
- Spouse’s coverage ends with employer due to termination or reduction of hourse
- COBRA exhausted
- Qualified Medical Child Support Order
- Child turns 26
For prescription drugs, you will need to pay the full price, but reimbursement will be made to you after you receive your ID card. Send a copy of the receipt with a direct reimbursement claim form to Express Scripts.
For medical claims, your provider can verify you were hired and have medical coverage through your HR department. When you receive your ID card, all verifications of benefits should be made by calling the number on your medical plan ID card.
Your OHP medical plan document and dental plan document explains who can be covered, how to file a claim and other important information on how your plan works. You may also call the customer service numbers on your medical or dental cards for benefits questions.
It is a federal law that regulates how covered entities such as health care providers and health plans, including Ohio Healthcare Plan, may use and disclose protected health information (PHI). Many provisions of HIPAA became effective on April 14, 2003.
The OHP has always respected the privacy of personal health information of individuals in the plan and handled it securely. Ohio state law has provided protection for individual’s personal health information. And now, federal law provides further protection for individual’s health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Continuation of Coverage- Consolidated Omnibus Budget Reconciliation Act (COBRA)
COBRA is a federal law which requires each group health plan to allow employees and eligible dependents to continue their group coverage for a stated period of time following a qualifying event that causes the loss of group health coverage. COBRA allows you or your eligible dependent to remain in OHP for a specified number of months at 102% of the current premium cost. Qualifying events include reduced work hours, child reaching age 26, death or divorce of a covered employee, and termination of employment.
How do I elect COBRA?
You must notify your Human Resources or Benefits Department on an OHP enrollment/change for of the qualifying event. Your employer will notify EBMC who will send a COBRA notice describing your COBRA rights, the COBRA rates and an enrollment form. You must decide within 60 days from the date of the notice or the date coverage under the plan ends if you want to elect COBRA.
My son will turn 26. Will he be covered under my medical plan?
No. His coverage ends at the end of the month in which he turns 26. EBMC will notify you that his coverage will end and provide you with COBRA information.
My divorce is final. What steps do I take regarding my ex-spouse’s coverage?
You MUST notify your employer within 60 days of your divorce. Failing to do so will result in a forfeiture of their right to continue coverage through COBRA.