Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-12 - Open enrollment

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to implement the open enrollment
				statute, sections 3923.58 and
				3923.581 of the Revised
				Code. This rule requires
				carriers to provide information to consumers, insurance agents and to the
				superintendent, pursuant to section
				3923.582 of the Revised Code.
				The open enrollment requirements in this rule apply to any carrier that is in
				the business of issuing health benefit plans to individuals and/or non-employer
				groups.
(B) Authority
This rule is promulgated pursuant to the authority stated in
				sections 3901.041 and
				3923.582 of the Revised Code.
				Pursuant to section 610.53 of
				Amended Substitute House Bill 49 of the 132nd General Assembly, during
				the period beginning on January 1, 2014, and expiring
				January 1, 2022, the operation of sections
				3923.58,
				3923.581 and
				3923.582, of the Revised Code
				are suspended. As a result, carriers shall not be required to offer open
				enrollment coverage under the "Ohio Open Enrollment Program" on or after
				January 1, 2014. Therefore, during the period beginning on January 1, 2014, and
				expiring January 1, 2022, the operation of this rule also is
				suspended. If the amendments made by
				42 U.S.C.
				300gg-1 and
				300gg-6,
				regarding the requirements related to health insurance coverage,
				
				become ineffective prior to the expiration of the suspension of
				January 1, 2022, then sections
				3923.58,
				3923.581 and
				3923.582 of the Revised Code and
				this rule, in either their present form or as they are later amended, again
				become operational.
(C)
			 Advertisement of open enrollment coverage
Carriers subject to the requirement to provide open enrollment
				coverage under sections
				3923.58 and
				3923.581 of the Revised Code
				shall comply with the following steps by the dates specified.
(1) Each carrier shall provide to the
			 superintendent by November 1, 2009, a toll free number that will be used to
			 accept public inquiries on open enrollment coverage. The carrier shall make
			 this number available to the public, beginning December 1, 2009.
(2) The toll free number will be answered
			 during the carrier's normal business hours.
(3) Each carrier shall develop a web page, by
			 January 1, 2010, providing notice of the availability of the open enrollment
			 coverage being offered pursuant to the terms of this rule. The open enrollment
			 web page must be easily accessible to visitors to the home page of the
			 carrier's web site.
(4) The web
			 page shall include a table of premium rates to enable a consumer to calculate
			 the maximum premium that would be charged to a person of the same age, gender,
			 geographic location and plan selection.
(5) The web page shall be available at all
			 times and kept as current as possible.
(6) A carrier shall inform an applicant that
			 has been denied other health coverage by that carrier of the availability of
			 open enrollment coverage with that carrier.
(7) Each carrier shall make coverage
			 applications available online for consumers or insurance agents to fill out or
			 print and mail to the company. Carriers shall also provide an online contact
			 person who shall answer queries within two business days.
Carriers must notify applicants, or their agents of record, of
				the acceptance or rejection of their application within five business days of
				receipt of a completed application. Carriers may adjust the terms of coverage
				as necessary in the event subsequent receipt of relevant documents requires. If
				the carrier offers coverage subject to a waiting period under section
				3923.581 of the Revised Code,
				the first day of the waiting period shall be the date of receipt of the
				completed application. No carrier may require enrollment to be made in person.
				Carriers may accept applications for coverage online, by phone or by mail. A
				representative of the carrier may contact an agent or applicant who has
				submitted an application in order to explain the operations of the carrier and
				to answer any questions the agent or applicant may have. Every carrier shall
				make open enrollment applications and solicitation documents readily available
				to any potential agent or applicant who requests such
				material.
(8) The following
			 information shall be made available on the carrier's web page:
(a) Open enrollment will begin on January
			 first of each year and will remain open until the carrier has reached its
			 statutory limit;
(b) A clear
			 explanation of "Federally Eligible Individuals" ("FEI") and non-"FEI"
			 individuals including the eligibility requirements for each open enrollment
			 product offered by the carrier; the differences between the "Basic" and
			 "Standard Plan" and any other open enrollment coverage offered. A carrier may
			 use appendix "A" to this rule to satisfy this requirement;
(c) Under what circumstances an eligible
			 applicant or the applicant's dependents may be subject to a preexisting
			 condition limitation;
(d) The
			 address and web site where a person may obtain an application, if different
			 from the open enrollment web site;
(e) The telephone number that a customer may
			 call and hours of operation and an e-mail address in order to request an
			 application or to ask questions;
(f) The date the first payment will be
			 due;
(g) A rate calculator or a
			 page that would allow a consumer to calculate the actual or maximum premium
			 that would be charged to a person of the same age, gender, geographic location
			 and plan selection; if the rate provided is the maximum rate, the web page
			 shall explain in what circumstances the actual rate will vary;
(h) Information regarding the carrier's
			 waiting list, if the carrier maintains one; the process of getting on the
			 waiting list; and the process by which the carrier shall notify applicants of
			 enrollment decisions.
(9)
			 Information regarding open enrollment must be easily accessible to callers of
			 the toll free telephone number. Persons answering the toll free telephone
			 number must be adequately trained and informed about the open enrollment
			 process. In addition to the information required in paragraph (D)(8) of this
			 rule, persons answering the toll free number must be able to answer customer
			 questions and provide the actual rate, or the maximum rate, that will be
			 applicable to the eligible applicant for all open enrollment products offered
			 by the carrier.
(10) No carrier may
			 employ any scheme, plan, or device that restricts the ability of any person to
			 enroll during open enrollment.
(11)
			 The carrier shall electronically certify on a form prescribed by the
			 superintendent if and when it has met the enrollment limit. In addition, the
			 carrier shall provide a status update to the superintendent with regard to any
			 waiting list, if the carrier maintains a waiting list, on the fifth business
			 day of the month for the previous month. The status update must also report
			 when the carrier reopens enrollment in order to maintain its enrollment limit.
			 A carrier that does not maintain a waiting list must explain to the
			 superintendent how it will maintain its enrollment limit as current enrollees
			 drop off.
(12) The superintendent
			 will provide on the department of insurance web site a common access point for
			 open enrollment information. The following information may be included:
(a) Carriers' toll free numbers;
(b) Links to carriers' open enrollment web
			 page;
(c) Whether a carrier's open
			 enrollment program is open or closed;
(d) Other information as the superintendent
			 deems appropriate.