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.
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.
HIV PROVIDERS
Providers must contract with each of the plans in the marketplace individually in order to fully participate in the Alabama Health Benefit Exchange.
This process is similar to enrolling in insurance or managed care organization provider networks. See below for a list of insurers participating in the state marketplace, and information on 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.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them.
If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any otherproblems related to the Affordable Care Act, please report these problems to the state office of insurance:
0 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 HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in the Alabama Health Benefit Exchange.
Alabama has established Blue Cross Blue Shield of AL 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/
Provider Enrollment: http://www.aetna.com/healthcare-professionals/join-aetna-network/join-provider-network.html
Plan types offered: Individual
Ambetter from Buckeye Community Health Plan
Plan Website: http://www.bchpohio.com/for-members/members/
Provider Enrollment: http://www.bchpohio.com/for-providers/become-a-provider/
Plan types offered: Individual
Anthem Blue Cross and Blue Shield
Plan Website: https://www.anthem.com/health-insurance/Ohio/health-plans/
Provider Enrollment: http://www.anthem.com/wps/portal/ahpprovider?content_path=provider/nv/f5/s2/t0/pw_002297.htm&state=nv&label=Become%20an%20Anthem%20Blue%20Cross%20and%20Blue%20Shield%20Network%20Provider
Plan types offered: Individual, SHOP
Assurant Health
Plan Website: http://www.assuranthealth.com/corp/ah/AHHome.htm
Provider Enrollment: http://www.assuranthealth.com/corp/ah/Providers/health-care-provider.htm
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/
Provider Enrollment: https://www.caresource.com/providers/ohio/plan-participation/
Plan types offered: Individual
HealthSpan
Plan Website: http://www.healthspannetwork.com/members
Provider Enrollment: http://www.healthspannetwork.com/providers/credentialing/
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
Plan Website: https://www.humana.com/individual-and-family/products-and-services/medical-plans/
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)
Plan Website: http://www.healthspannetwork.com/members
Provider Enrollment: http://www.healthspan.org/providers
Plan types offered: SHOP
MedMutual
Plan Website: https://www.medmutual.com/
Provider Enrollment: https://provider.medmutual.com/Become_a_Network_Provider/Main.aspx
Plan types offered: Individual, SHOP
Molina Marketplace
Plan Website: http://www.molinahealthcare.com/members/oh/en-us/pages/home.aspx
Provider Enrollment: http://www.molinahealthcare.com/members/common/en-US/abtmolina/compinfo/Pages/contactus.aspx#
Plan types offered: Individual
Paramount Insurance Company
Plan Website: http://www.paramounthealthcare.com/marketplace
Provider Enrollment: http://www.paramounthealthcare.com/ClinicalPracticeGuidelines
Plan types offered: Individual
Premier Health Plan, Inc.
Plan Website: http://www.premierhealthplan.org/
Provider Enrollment: http://www.premierhealthplan.org/Providers/
Plan types offered: Individual
SummaCare Inc
Plan Website: http://www.summacare.com/
Provider Enrollment: http://www.summacare.com/Provider/BecomeANetworkProvider.aspx
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