Group Health Plan Advisory (COVID-19): Ohio Department of Insurance Notice

March 23, 2020

The Ohio Department of Insurance issued a bulletin on March 20, 2020, providing relief from certain insurance regulations.

The bulletin was issued in response to the request from Governor Mike DeWine to state agencies to develop and implement procedures designed to prevent or alleviate the public health threat from COVID-19. Carriers providing fully insured health plans, stop loss insurance policies and employers providing self-insured health plans (collectively Insurers) must follow the bulletin’s requirements. The requirements are detailed below.

Employee Eligibility
Many employers are decreasing their employees’ hours of work. In some cases, the reductions cause the number of work hours to fall below an Insurer’s eligibility threshold. The requirements prohibit insurers from discontinuing coverage to employees under group policies regardless of any “actively at work” or similar eligibility requirements in the plan. Additionally, insurers are prohibited from increasing premium rates based on a group’s decreased enrollment due to COVID-19.

Grace Period for Premium Payment
Insurers must give their policyholders a 60-day grace period for premium payments. The grace period is based on the original premium payment due date and must be interest-free.

Continuation Coverage

  • Employers with 20 or more employees – employees may elect COBRA coverage if one person remains actively employed.
  • Employers with less than 20 employees – employees may elect Ohio State continuation coverage for up to 12 months if one person remains actively employed and enrolled in the plan.
  • If no active employees remain covered under a plan – COBRA and continuation coverage are not available; impacted employees will be eligible for a special enrollment period.

Special Enrollment

  • Employees losing coverage are eligible for a special enrollment period to enroll in new coverage.
  • Individuals and their families applying for coverage on the federal exchange are able to qualify for premium subsidies if they meet the criteria – plans are effective on the first day of the next month after enrollment.
  • Employees buying policies outside of the federal exchange – insurers must waive normal special enrollment procedures and allow applicants to obtain coverage effective the day after the loss of their employment.

Other Considerations

  • At this point, the Ohio Department of Insurance Notice only applies to health insurance coverage and does not impact Dental, Vision, Life or Disability coverages. Oswald Companies is already following up with the carriers that provide those coverages to see if they will be offering premium extensions.
  • This is Ohio specific guidance and does not impact health insurance coverage that is sited in other states. The Oswald Companies Compliance Team is monitoring other states and the Federal Government; we will provide further guidance as it becomes available.

The bulletin expires upon the expiration of the state of emergency declared by Governor DeWine on March 9, 2020.

Please contact your Oswald client team representative for further information.

Oswald Companies | Health Care Reform Implementation
Danielle Jarvis, Compliance Team Leader | 216.649.7384
Luke Clark, Sr. Benefits Consultant | 216.367.8758

Disclaimer: Materials are solely for informational purposes as an educational resource. Please contact counsel to obtain advice with respect to any specific issue.