Ohio Adopts Emergency Rule for Children with Pre-Existing Conditions

The Ohio Department of Insurance has issued an emergency rule to better protect children under age 19 with pre-existing medical conditions by establishing uniform open enrollment periods in Ohio’s individual market for coverage to be secured

“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,” said Mary Jo Hudson, Director of the Ohio Department of Insurance. “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) addresses concerns that insurance for children under age 19 with pre-existing medical conditions would only be purchased for brief periods of time when the purchaser knows that the child will need medical care. This phenomenon is called “adverse selection” and it exposes insurance companies to unfair financial risk because the pool of those insured disproportionately includes those who will be making claims. Because insurance companies can choose to entirely avoid selling individual health insurance policies to children under age 19, their desire to avoid the financial risk associated with carefully timed insurance purchases for children with pre-existing conditions may lead some insurance companies to stop selling individual health coverage to them.

Requiring all insurers selling individual policies for children under age 19 to accept insurance enrollments for children at the same time, and for the same length of time, during specified “open enrollment periods,” will provide a level playing field. That, in turn, will encourage insurers to continue to make the coverage available.

Insurance companies offering individual coverage to children under the age of 19 are now required to hold a one-time transitional open enrollment period from September 23, 2010 until November 15, 2010. Additionally, beginning in July 2011, insurers writing individual coverage for children under age 19 are to hold an open enrollment period each July, for the entire month, and each January, for the entire month. Not all health insurers offer these policies, so please check with an agent or insurer to determine where to purchase this coverage.

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 www.registerofohio.state.oh.us.

Topics Carriers Ohio