Ohio Enacts Emergency Open Enrollment Rule

September 29, 2010

In order to improve protection for children under the age of nineteen who have pre-existing medical conditions, the Ohio Department of Insurance has issued an emergency rule establishing uniform periods of open enrollment in the state’s individual insurance market.

According to the director of the Ohio Department of Insurance, Mary Jo Hudson, “Recently enacted federal health care reforms provide that children under age 19 cannot be denied coverage or subjected to coverage limitations or exclusions because of a pre-existing health condition. We have issued this emergency rule to lessen confusion and uncertainty in the marketplace for consumers and insurers and to level the playing field for insurers offering this coverage. The rule also will make consumers more aware of children’s coverage while providing guidance to Ohio insurers so they can comply with new federal law requirements in Ohio.”

The rule (3901-8-14) is designed to address the worry that insurance for children under age 19 with pre-existing medical conditions would only be available during limited periods of time when the purchaser knows that the child will require medical care. This “adverse selection” phenomenon exposes is thought to expose insurance companies to unfair financial risk because it increases the percentage of policy holders who will definitely be making claims. Since insurers have the right to not sell individual health insurance policies to children of that age, the financial risk involved with carefully timed policy purchases for children with pre-existing condition could result in some insurance companies not selling policies to children under the age of 19.

The Ohio rule, which will require all insurance companies which sell policies for children under the age of nineteen to accept them as new clients during specified open enrollment periods, will make the proverbial playing field a bit more even, which will allow the insurers to continue offering the product.

Currently, insurers are having a one-time transitional open enrollment period that began on September 23rd and will end on November 15th. Beginning in July, 2011, open enrollment periods will be each July and January (all month long).

This emergency rule can be found under Featured Links on the Department’s website, www.insurance.ohio.gov or on the Register of Ohio web site at registerofohio.state.oh.us