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Ohio Limits Basic Coverage Rates

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The Buckeye State is restricting how much insurers can charge individual health insurance buyers who have chronic health problems.

Ohio Gov. Ted Strickland, D, imposed the rate cap by signing an executive order, according to officials at the Ohio Department of Insurance.

“The Ohio Revised Code authorizes the governor, on request of an agency, to suspend the normal rule-making procedures with respect to a specific rule when an emergency exists necessitating the immediate adoption, amendment or rescission of the rule,” Ohio department officials say. “When such a determination is made, the agency may immediately adopt, amend, or rescind a rule, but the rule is valid only for 90 days.”

The new Open Enrollment Emergency Rule executive order was filed Oct. 20, officials say.

The emergency rule affects the Ohio Open Enrollment Health Insurance Program, a program that provides health coverage for Ohio residents who have pre-existing health problems such as diabetes or cancer.

The next open enrollment period is set to start Jan. 1, 2010.

Insurers selling coverage through the program must limit the rate they charge an enrollee to “150% of the lowest rate charged to a person of similar age and gender,” Ohio department officials say.

Ohio department officials expect the change to reduce open enrollment premiums by at least 50%.

The Ohio Association of Health Underwriters, Columbus, Ohio, has posted analyses of the emergency rule in the legislative update and legsislative review sections on its website.

“No carrier may employ any scheme, plan, or device that restricts the ability of any person to enroll during open enrollment,” OAHU analysts write in a summary of the emergency rule.

But Ohio regulators did change the emergency rule to clarify the role of agents in representing consumers during the open enrollment process, the analysts write.

The Ohio Association of Health Plans, Columbus, Ohio, has “concerns that the rate caps and enrollment requirements will increase premiums in the individual marketplace,” OAHP President Kelly McGivern says in a statement. “Unfortunately, the caps are so low that some healthier individuals may pay a higher premium than someone who has more health conditions and is receiving coverage through the enrollment program.”

Ohio health insurers are committed to following the new requirements and helping people who have been shut out of the individual marketplace get coverage, but, “ultimately, we hope that a more global solution can be achieved through federal health reform that covers all Americans, reduces costs, and improves the quality of care for all Americans,” McGivern says.


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