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Am I Eligible?


To qualify for the Ohio High Risk Pool, you must meet the following eligibility criteria, as established by the U.S Department of Health and Human Services:

  • Be a citizen or national of the United States or lawfully present in the United States;
  • Be an Ohio resident at the time of application;
  • Be uninsured for six months prior to the date you apply for coverage;
  • Have a qualifying pre-existing condition as evidenced by a denial of coverage by two insurers, or by documentation from a health professional.

In addition, you will have to supply the following items during the application process to verify eligibility:

  • Proof of U.S. citizenship
  • A copy of ONE of the following:
  • Birth certificate
  • Passport
  • Certificate of citizenship
  • Naturalization certificate
  • Visa or immigration documents
  • Proof of Ohio residency
  • A copy of ONE of the following:
  • Ohio driver’s license or state identification card
  • Payroll stub
  • Voter registration card
  • Utility bills
  • Rental agreement
  • Ohio income tax return
  • Evidence of a pre-existing condition
  • A copy of ONE of the following:
  • A completed provider certification form
  • OR
  • Letters or documents from two carriers verifying each has refused to issue creditable coverage to you within the previous six months or would issue coverage only with an exclusionary rider
  • OR
  • Written certification by a licensed physician or nurse practitioner, issued within the past six months, certifying that you have a history of or suffer from a qualifying medical or health condition and contains your healthcare provider’s name, address, phone number, degree, specialty, license number and state
  • First month’s contribution payment
  • Payment options:
  • Check (made payable to Medical Mutual of Ohio)
  • OR
  • Money order (made payable to Medical Mutual of Ohio)

Additional details about approved documentation can be found on the application form. The amount of the first month’s contribution payment can be obtained by reviewing Ohio High Risk Pool rates or by calling customer service at 877/730-1117

If you meet all of the eligibility requirements, Get a Quote for the Ohio High Risk Pool program.

Medical Mutual is no longer the administrator of the Ohio High Risk Pool program on behalf of the U.S. Department of Health & Human Services (HHS). We submitted a proposal to HHS to operate the program through the end of the year, but HHS decided to transfer all Ohio members to the federally run Pre-existing Condition Insurance Plan (PCIP) effective July 1, 2013. For individuals who were enrolled in the Ohio High Risk Pool, your coverage with Medical Mutual ended on June 30, 2013. This includes coverage under our Disease and Case Management programs.

Your information was transferred to the federally run PCIP and in mid-June, you should have received an enrollment letter, an invoice for your July premium, and additional information from the National Finance Center, which is the enrollment administrator of the federal PCIP.

If you have any questions about your PCIP coverage, please call the National Finance Center at (866) 717-5826, Monday through Friday, 8 a.m. to 11 p.m. ET. You can also visit pcip.gov or pciplan.com.

If you have any questions about your Ohio High Risk Pool coverage or claims for services received prior to your transition to PCIP on July 1, 2013, please call Medical Mutual at (877) 730-1117.

Access to the coverage and doctors you need through the Ohio High Risk Pool