Representing Ohio’s Leading Health Insurance Agents
INDIVIDUAL MARKET OPEN ENROLLMENT BEGINS
Ohio’s newly revised open enrollment program for uninsurable Ohioans is now in effect. The program, which requires all insurers in Ohio’s individual and non-employer group market to participate, was one of the health care reform measures included in Ohio’s recently enacted biennial budget. Below is a summary of the program’s requirements:
- Individual Market Open Enrollment for Uninsurable persons – applies to HICs, federally eligible (FEI) and non-federally eligible individuals (non-FEI) – ORC Sections 1751.15, 1751.16, 1751.18, 3923.122, 3923.58, 3923.581 and 3923.582
- Open enrollment rates for basic and standard plans for Health Insuring Corporations (HICs) and Sickness and Accident Insurers (health insurers) for individuals and non-employer groups are capped at 2 times the base rate for calendar years 2010 and 2011. The “base rate” is defined as the lowest premium rate for new or existing business prescribed by a HIC or health insurer for the same or similar coverage under a plan or arrangement covering any individual with similar case characteristics.
- For calendar year 2012 and every year thereafter, rates are capped at 1½ times the base rate.
- However, if ODI determines that the 2010 cap has resulted in an increase in the market-wide average medical loss ratio for coverage sold to individual insureds and non-employer group insureds, including open enrollment insureds, of more than 5.25 percentage points, the 2010 and 2011 cap shall remain in effect.
- During 2010 and 2011, each carrier shall accept into open enrollment up to 4% FEIs and 4% non-FEIs of the carrier’s total number of individual or non-employer group insureds in this state; for 2012 each carrier shall accept up to 8% FEIs and 8% non-FEIs.
- HICs will no longer have to issue a public notice in the newspaper announcing their open enrollment period.
- A carrier may pay an agent a commission of not more than 5% of the premium charged for the initial placement and not more than 4% of the premium charged on renewal.
- These new open enrollment provisions became effective January 1, 2010.
The Ohio Department of Insurance has provided the following information concerning how to contact insurers participating in the open enrollment program:
OAHU Association Office: 1545 W. 130th Street, Suite A2, Hinckley, OH 44233
Phone 330-273-5756 · Fax (216) 803-9900 · admin@ohioahu.org
Government Affairs Office
John McGough & Keith Shoemaker · 100 South Third Street · Suite 111 · Columbus, OH 43215
Phone: 614-221-5771 · Fax: 614- 221-2865 · jmcgough@mcgough-inc.com · kshoemaker@mcgough-inc.com