Insurance Alert: Ohio Department of Insurance Imposes Certain Obligations Upon Health Insurance Companies & Provides Premium Relief for Companies

Earlier this week, the Ohio Department of Insurance (ODI) issued a series of bulletins that require health insurance companies to provide certain relief to Ohio companies with respect to their fully-insured group medical policies.

For example, in ODI Bulletin 2020-03, the ODI ordered health care insurance companies, including stop loss insurers, to comply with the following requirements during the entity of the state of emergency declared by Governor DeWine related to the COVID-19 pandemic:

• Allow employers to continue covering employees under group medical policies even if such employees would otherwise become ineligible due to a decrease in the number of hours worked. For example, many policies state that coverage is only provided to active employees who work more than 30 hours per week. Thus, if an active employee’s average weekly hours were to dip under the 30 hour threshold, such employee would typically lose coverage under the group health plan. However, under the terms of the ODI Bulletin, any such “actively employed” or minimum hours requirements related to eligibility must be disregarded.

• Insurance companies operating in Ohio are also prohibited from increasing premiums based upon decreasing enrollment due to COVID-19. Indeed, many health insurance policies provided that premiums can be adjusted by the insurer if the covered population changes by more than 10%. Any such contractual provisions are now rendered unenforceable during the state of emergency.

• Employers are also provided with the option of deferring premiums under their insurance policy for up to 60 calendar days interest-free. This grace period may be of interest to many employers who have been dramatically impacted by COVID-19.

Further, in ODI Bulletin 2020-05, the ODI ordered that:

• Any and all testing and treatments related to COVID-19 must be deemed an emergency medical condition. Thus, health insurance companies must cover such testing and treatment at the same cost-sharing level as in-network coverage and cannot require prior authorization.

As the State of Ohio attempts to navigate the numerous issues arising from COVID-19, Brouse McDowell will continue to provide updates on any other orders as may be issued directly by the Governor’s office or by the Ohio Department of Insurance. Contact Brouse McDowell if you have any questions related to this Alert or need assistance with respect to any insurance related matter.