What state legislation is new for 2010?
A state budget bill, Ohio House Bill 1, which was passed in July 2009, contains modifications and new enactments to insurance regulations. These modifications include changes to open enrollment requirements, changes to the external appeals process, enactment of electronic payment to providers and a new provision that mandates an extension of coverage for dependents reaching attainment age who are covered by a parent or guardian’s health insurance policy.
In an effort to allow more uninsured individuals access to health insurance, House Bill 1 significantly increases the caps on the number of individuals that insurers and health insurance companies are required to accept during their annual open enrollment periods. In the past, health insurers were required to offer an open enrollment period (typically one month) in which any individual, regardless of pre-existing health conditions, could apply for health insurance, provided that he or she had not had 18 months of continuous group health coverage. Beginning in January 2010, House Bill 1 will allow more people to be approved for coverage during a year-round open enrollment period, as well as limit the rate health insurers can charge for open enrollment plans and conversion coverage. These cap and rate limitations will be phased in over a three-year period.
The second provision of House Bill 1 includes changes to the external appeals process. It mandates that insurers initiate an external review for all appeals that the Ohio Department of Insurance considers to require the resolution of a medical issue. Under certain circumstances, the bill changes the time period in which the insured may request an external review from 60 days to 180 days.
The third provision of House Bill 1 requires electronic payment to providers who submit claims electronically to insurers, as well as updated reporting and filing requirements to the Ohio Department of Insurance.
Effective July 1, 2010, the bill mandates all fully insured group, conversion and open enrollment plans extend coverage to all unmarried adult children from the attainment age of 19 to their birth date age of 28. Eligibility requirements state that the adult child must be a resident of the state of Ohio or a full-time student at an accredited public or private institution of higher education; cannot be employed by an employer that offers any health benefit plan under which the child is eligible for coverage; and cannot be eligible for Medicaid or Medicare. Extension of coverage is not automatic. A request must be made to the employer and the contract holder may be required to pay the entire premium for unmarried adult child coverage.
How can employer groups prepare for new legislation?
To prepare for new legislation and to be compliant with the law, employer groups who offer health insurance to their employees should work with their health insurers, independent insurance agents or their ERISA attorneys to select or design a package that meets their needs and budget, while offering appropriate coverage for all employees.
JUDITH A. MACRO is the vice president of corporate services and the compliance officer at SummaCare, Inc. SummaCare, Inc., a provider-owned health plan located in Akron, Ohio, services members in an 18 county service area through a network of over 7,000 providers and many top hospitals. Macro can be reached at [email protected].
