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HIV and Enteropathy
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Ohio State Insurance Exchange
Exchange:
The Ohio Insurance Exchange (Marketplace) is the Federally-Facilitated Marketplace.
The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).
General information about the Federally-facilitated Marketplace can be found at: https://www.healthcare.gov/marketplace/individual/#state=ohio.
Learn more: Background
Patients:
The Ohio Health Insurance Exchanges is essentially a marketplace for individuals to shop for health insurance if they do not already have insurance coverage from another source. If individuals have insurance from another source such as employment, retirement benefits, or spousal benefits, they do not need to obtain it from the Marketplace.

The Ohio AIDS Coalition has published a guide analyzing plans in the Ohio Exchange for coverage points required by HIV patients:  Ohio Plans Analysis Tool

HIV Providers:
Providers must contract with each of the Qualified Health Plans offered in the marketplace individually to participate fully in the Federally-facilitated Marketplace.
This process is similar to enrolling in insurance or managed care organization provider networks. See below the list of insurers participating in the Federally-facilitated Marketplace, and information about contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.

Learn More
: Health Reform & My Practice

Reporting Problems

The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are
experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:

50 W. Town Street
Third Floor - Suite 300
Columbus, Ohio 43215
(614) 644-2658


www.insurance.ohio.gov/
Complaints: http://www.insurance.ohio.gov/Consumer/Ocs/pages/ConsCompl.aspx

Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

Qualified Health Plans Participating In the Exchange:
Below is a list of the Qualified Health Plans that have publically announced that they will offer plans in the Federally-facilitated Marketplace.
Ohio has established Community Insurance Company (Anthem Blue Cross Blue Shield) as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates.
Aetna
Plan Website: http://www.aetna.com/
Plan types offered: Individual
 
Ambetter from Buckeye Community Health Plan
Plan types offered: Individual
 
Anthem Blue Cross and Blue Shield
Plan Website: https://www.anthem.com/health-insurance/Ohio/health-plans/              
Plan types offered: Individual, SHOP
 
Assurant Health
Plan types offered: Individual
 
AultCare Insurance Company
Plan Website: http://www.aultcare.com/           
Provider Enrollment: http://www.aultcare.com/providers          
Plan types offered: Individual, SHOP
 
CareSource Just4Me
Plan Website: https://www.caresource.com/   
Plan types offered: Individual
 
HealthSpan
Plan types offered: Individual, SHOP
 
HealthSpan Integrated Inc
Plan Website: http://www.healthspan.org/       
Provider Enrollment: http://www.healthspan.org/providers      
Plan types offered: Individual
 
Humana Insurance Company
Provider Enrollment: https://www.humana.com/provider/medical-providers/network/              
Plan types offered: Individual
 
InHealth Mutual
Plan Website: http://www.inhealthohio.org/    
Provider Enrollment: http://www.inhealthohio.org/provider-portal       
Plan types offered: Individual
 
Kaiser Permanente (Operated by HealthSpan)
Provider Enrollment: http://www.healthspan.org/providers      
Plan types offered: SHOP
 
MedMutual
Plan Website: https://www.medmutual.com/  
Plan types offered: Individual, SHOP
 
Molina Marketplace
Plan types offered: Individual
 
Paramount Insurance Company
Provider Enrollment: http://www.paramounthealthcare.com/ClinicalPracticeGuidelines              
Plan types offered: Individual
 
Premier Health Plan, Inc.
Provider Enrollment: http://www.premierhealthplan.org/Providers/    
Plan types offered: Individual
 
SummaCare Inc
Plan Website: http://www.summacare.com/    
Plan types offered: Individual, SHOP
 
UnitedHealthcare
Plan Website: http://www.uhc.com/health_reform_guide.htm                               
Provider Enrollment: http://www.uhc.com/physicians/join_our_network.htm                 
Plan types offered: Individual
 

 

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