Health insurance questions on the Ohio exam blend national plan design with Ohio-specific mandates and continuation rights. This guide reviews the building blocks of medical plans—how HMOs, PPOs, and indemnity plans differ, plus the cost-sharing terms and the ACA's coverage floor—then concentrates on the Ohio rules you must know: small-employer continuation (mini-COBRA), the conversion privilege, mandated benefits, and the consumer protections enforced by the Ohio Department of Insurance (ODI).

National fundamentals (the quick review)

Medical plans differ mostly in how they balance cost, choice, and network:

• Indemnity (fee-for-service) – pays a share of covered charges with broad provider choice; the insured handles deductibles, coinsurance, and often files claims.
• HMO (Health Maintenance Organization) – lowest cost, network-only care, usually a primary care physician (PCP) and referrals to see specialists; emphasizes preventive care.
• PPO (Preferred Provider Organization) – a network of "preferred" providers with lower cost in-network and partial coverage out-of-network; usually no referral needed.
• EPO (Exclusive Provider Organization) – network-only like an HMO (little or no out-of-network benefit) but usually no PCP/referral requirement.
• POS (Point of Service) – a hybrid that uses a PCP/gatekeeper like an HMO but allows out-of-network care like a PPO.

Universal cost-sharing terms—premium, deductible, copay, coinsurance, and out-of-pocket maximum—apply across all of these. Plans are also sold two ways: group (employer-sponsored, generally cheaper, lighter individual underwriting) versus individual (bought directly by a person).

The ACA coverage floor

The federal Affordable Care Act (ACA) sets a baseline for most major medical plans that the exam treats as a given:

• Guaranteed issue – carriers cannot decline an applicant based on health.
• No health-based rating – premiums vary only by age, geography, tobacco use, and family size, not by medical history.
• Pre-existing conditions covered – no exclusion or waiting period for prior conditions.
• Essential Health Benefits (EHBs) – ten required categories (e.g., hospitalization, prescription drugs, maternity, mental health, preventive care).
• Dependents to age 26 – adult children may stay on a parent's plan until 26.

Ohio continuation: small-employer "mini-COBRA"

Federal COBRA applies to employers with 20 or more employees and allows continuation for 18 (sometimes up to 36) months. Ohio fills the gap for smaller employers with a state continuation ("mini-COBRA") right:

• Who it covers: employees of small groups below the federal 20-employee COBRA threshold.
• How long: continuation is commonly cited as up to ~12 months—verify the current statutory figure, as Ohio's continuation period has been stated differently over time.
• Cost: the participant generally pays the full premium (the employer's former share included).
• Electing: the employee must elect within the short window stated in the notice; the employer/insurer is responsible for giving notice of continuation rights.

Qualifying events mirror federal COBRA: termination (other than gross misconduct), reduction in hours, divorce, a dependent aging out, and death of the covered employee.

Conversion privilege

Separate from continuation, Ohio group health contracts typically include a conversion privilege: when group coverage ends, an eligible person may convert to an individual policy on a guaranteed-issue basis—no new evidence of insurability, usually by applying within a set window after the group plan terminates. Conversion benefits may be narrower than the group plan. On the exam, distinguish continuation (keeping the same group coverage temporarily) from conversion (moving to an individual policy).

Ohio mandated benefits, Medicaid, and the marketplace

• Mandated benefits: Ohio requires insured plans to include certain categories—commonly cited examples include newborn and maternity coverage, mammography/cancer screenings, autism spectrum disorder treatment, mental health parity, and diabetes supplies. Treat any specific cap or age limit as the statutory figure of the time; self-funded ERISA plans are generally exempt.
• Ohio Medicaid: the joint federal-state program for low-income residents; Ohio expanded Medicaid under the ACA, and most enrollment runs through managed-care plans.
• ACA marketplace: Ohio does not run its own exchange—residents enroll through the federal exchange at healthcare.gov.

Required provisions and timelines

Key Ohio numbers to memorize

Common exam traps

• Confusing COBRA and mini-COBRA. Federal COBRA = 20+ employees; Ohio continuation = groups below 20.
• Mixing up continuation and conversion. Continuation keeps the group plan temporarily; conversion moves you to an individual policy (guaranteed issue).
• Assuming Ohio runs its own exchange. Ohio uses the federal marketplace at healthcare.gov.
• Health-rating an ACA plan. Premiums vary by age, area, tobacco, and family size—not medical history.
• Asserting exact mandate caps or the continuation length. These change—describe them qualitatively and verify.
• Forgetting self-funded ERISA plans are usually exempt from state mandates.

Quick recap

Ohio medical-plan questions start with national plan design—indemnity, HMO, PPO, EPO, and POS—the universal cost-sharing terms, and the ACA floor (guaranteed issue, no health rating, pre-existing conditions covered, EHBs, dependents to 26). The state-specific spine is small-employer continuation (mini-COBRA) for groups below the federal 20-employee threshold, commonly cited as up to ~12 months (verify), distinct from the guaranteed-issue conversion privilege to an individual policy. Layer on Ohio's mandated benefits, expanded Medicaid, and the fact that Ohio uses the federal exchange (healthcare.gov), plus standard provisions—grace period, a ~10-day free look, 2-year incontestability, and prompt-pay. Keep the continuation-vs-conversion distinction crisp and remember the Ohio Department of Insurance is the regulator, and most OH health questions become reliable points.