What You Need to Know About Ohio’s Laws on Employer-Provided Health Care Coverage

Ohio law does not generally require employers to provide healthcare insurance to their employees. Here are all the specifics you need to know about employer-sponsored health insurance in Ohio.

While Ohio employers are not required by law to provide health insurance to workers, the majority usually do provide it. Employers can choose to self-insure and cover the costs of employee claims directly or insure workers through the Ohio Bureau of Workers’ Compensation. Businesses offering health care coverage to some employees must offer it to all eligible employees under the Affordable Care Act.

Ohio Employment-Sponsored Health Care Coverage

Ohio insurance laws do not force employers to provide health care coverage to their employees, but most employers still offer an insurance plan. The insurance plan can cover only the employee or include the employee’s family, usually depending on the size of the employer’s business.

Large employers may self-insure and pay their workers’ compensation directly out of pocket rather than pay a premium to an insurance company or independent third-party administrator (TPA). Self-insurers assume the risks associated with paying medical providers and are responsible for reviewing employee claims. Ohio law does not regulate self-insured plans with mandated benefits or continuation requirements. Employers who self-insure must meet the minimum compensation and benefits required by law.

Related: Ohio OSHA Regulations: Explained

Employers may alternatively pay premiums to Ohio’s workers’ compensation fund. The Ohio Bureau of Workers’ Compensation covers employees’ eligible claims. State-fund employers are two-thirds of Ohio’s total employers and can be private or public employers. Private employers include private businesses, limited liability companies, corporations, partnerships, and associations. Public employers are county or state agencies serving the public.

While states cannot regulate self-insurers, state-fund employers must abide by Ohio’s mandated benefits, continuation, and conversion provisions. Ohio complies with the federal Consolidated Omnibus Budget Reconciliation Act (COBRA), allowing eligible employees to continue receiving group health coverage after exiting the group. Terminated employees and their dependents who received coverage for at least three months can continue group health coverage for up to a year. The continuance does not apply if the employees voluntarily ended their employment or were dismissed due to gross misconduct. Employers must inform employees of their right to continue group health coverage upon the termination of employment.

The Affordable Care Act in Ohio

The Affordable Care Act (ACA) requires employers who provide health care coverage for some employees to offer coverage to all eligible employees. While Ohio does not penalize small businesses for failing to provide health care coverage to full-time employees, those providing insurance to only some employees violate Ohio law.

Ohio defines an eligible employee as working at least 30 hours per week. In contrast to the ACA, Ohio law excludes substitute and seasonal employees from the coverage requirement.

Related: Ohio Workplace Discrimination Laws

The ACA requires each state to provide a health insurance exchange for employees to consider different individual health care plans. Employees from Ohio without coverage from their employers, Medicaid, or Medicare can search the federal marketplace for insurance.

FAQs About Employers Providing Health Care Coverage in Ohio

What benefits do employers receive from providing health care coverage for their employees?

Small businesses with 25 full-time employees or less in Ohio may be eligible to receive health tax credits to cover the costs of employees’ health insurance premiums. The small business must contribute at least 50% of employee coverage, and the average annual wage per employee must be less than $50,000. Some intangible benefits for employers include higher worker productivity, an improved employee retention rate, and lower worker absenteeism.

How can I enroll in an employer-sponsored healthcare plan?

Employees offered health care coverage by their employer can apply to the group insurance health plan when the open enrollment period begins. The open enrollment period occurs once a year, and workers usually have to wait until the following year if they miss the deadline. Insurance carriers in employer-sponsored health care coverage do not consider the employee’s insurability when the employee applies.

What advantages does employer-sponsored insurance have over individual plans?

Employers providing coverage choose a health care plan without the employee having to do personal research. Employers often split premium costs with employees, and employer contributions are tax-exempt. Workers can make their contributions pre-tax and lower their total taxable income.

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