On June 18, 2021, the Department of Insurance issued Bulletin 2021-03, which replaces rescinded bulletins, including Bulletin 2020-03. 

As discussed in the March 31, 2020, Compliance Corner article “COVID-19 and Health Insurance Coverage Updates,” Bulletin 2020-03 provides guidance on certain employee eligibility, grace period, continuation of coverage and special enrollment requirements during the state of emergency.

Bulletin 2021-03 encourages insurers to provide flexibility to their insured during the ongoing COVID-19 public health emergency, including providing a grace period for premium payment and payment accommodations such as deferring payments at no cost, extending payment due dates, and waiving late or reinstatement fees. The bulletin defines insurers as health plan issuers which includes (but is not limited to) insurance companies, stop loss insurers, health insuring corporations, MEWAs and nonfederal governmental health plans.

While this guidance applies to insurers, employers should be aware of these developments.

Bulletin 2021-03 »

On March 3, 2021, Ohio Superintendent of Insurance French released Bulletin 2021-01, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2022, if the transitional policy ends by December 31, 2022. Previous bulletins referred to this as a “transitional policy,” but the new bulletin calls the policy a “non-enforcement” policy. The state has extended this transitional relief several times.

On January 19, 2021, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, if the state allows for such an extension. Such transition policies are not required to comply with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. The bulletin applies this most recent federal extension to Ohio and allows the issuer to renew these non-ACA compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan issued in the state should work with their advisors and insurers.

Bulletin 2021-01 »

On April 15, 2020, the Department of Insurance issued Bulletin 2020-09 which permits flexibility for timing of financial filings, electronic filings and on-site exams. Among filings eligible for extension, the Accountant’s Letter of Qualifications is eligible for a 30-day extension and the Audited Financial Report is eligible for a 60-day extension (both generally required for MEWAs).

Employers should be aware of these developments. For the full list of regulatory filings eligible for a filing extension, see “Attachment A” of Bulletin 2020-09.

Bulletin 2020-09 »

As explained in the March 31, 2020, Compliance Corner article “COVID-19 and Health Insurance Coverage Updates,” the Department of Insurance (the Department) released Bulletin 2020-03 providing guidance on certain employee eligibility, grace period, continuation of coverage and special enrollment requirements during the state of emergency.

Additionally, the Department has provided Frequently Asked Questions to Bulletin 2020-03 in response to the questions received regarding Bulletin 2020-03. Highlights include:

• Bulletin 2020-03 applies to fully insured health insurance plans and to certain self-insured employers such as MEWAs and some non-federal governmental plans. The bulletin does not apply to private self-insured plans (except for self-insured MEWAs and self-insured non-federal governmental health plans).
• Deferring premiums (which all insurers are required to provide the option to insureds up to 60 days) includes offering payment accommodations such as allowing consumers to defer payments at no cost, extending payment due dates or waiving late fees.
• Bulletin 2020-03 is applicable to insurers providing coverage to employer groups (when the Ohio Department of Insurance has regulatory jurisdiction over the health plan). The FAQs clarify that whether an employer allows employees a grace period to pay insurance premiums would be up to the individual employer.

Employers should be aware of these developments and review Bulletin 2020-03 and the Frequently Asked Questions for additional guidance.

Bulletin 2020-03 Frequently Asked Questions »
Bulletin 2020-03 »

On March 20, 2020, the Department of Insurance released Bulletins 2020-03 and 2020-05, and the Department of Medicaid (ODM) released Emergency Rules — all of which provide guidance on testing and/or treatment related to COVID-19 and its impact on health and welfare benefits administration.

As explained further in Bulletin 2020-03, Director Froment ordered insurers to comply with certain requirements such as:

• Insurers must permit employers to continue covering employees under group health plan coverage even if the employee would otherwise become ineligible due to a reduction in hours. In other words, insurers are required to allow employers to continue providing coverage to employees regardless of any “actively at work” provisions in the policies. Further, insurers are not permitted to increase premium rates based on decreased enrollment as a result of COVID-19.
• Insurers are required to provide an option to defer premium payments due for up to 60 calendar days from the premium due date (i.e., requiring a 60-day grace period for premium payment).
• Eligible employees may elect to continue coverage under COBRA (or state continuation coverage applicable to employers with less than 20 employees) as long as one person remains actively employed. However, if no active employees remain covered under a plan, COBRA and continuation coverage are not options and employees will be eligible for a special enrollment period in the health insurance exchange.
• Employees who lose coverage are eligible for a special enrollment period to enroll in new coverage. For plans on the federal exchange, coverage is effective the first day of the month following enrollment. For coverage outside for the federal exchange, insurers must allow individuals to obtain coverage effect the day after their loss of employment.

Director Froment further states in Bulletin 2020-05 that testing and treatment related to COVID-19 is considered emergency medical conditions so that such services must be covered without preauthorization and must be covered at the same cost sharing as if provided in-network (in the instance where an insured is directed to an out-of-network hospital for treatment and testing). Additionally, insurers must ensure coverage without balance billing for out-of-network emergency services.

Employers should be aware of these developments.

Bulletin 2020-03 »
Bulletin 2020-05 »

On March 10, 2020, Ohio Superintendent of Insurance Froment released Bulletin 2020-01, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2021, as long as the transitional policy ends by December 31, 2021. Previous bulletins have referred to this as a “transitional policy,” but this bulletin is calling the policy a “non-enforcement” policy (this transitional relief has been extended several times).

As background, on January 31, 2020, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Ohio and allows the issuer to renew these non-ACA compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 2020-01 »

On March 11, 2020, Director Froment released Bulletin 2020-02, notifying all insurance companies (and other entities in the State of Ohio that have delivered, issued, or used policies of sickness and accident insurance) of the superintendent’s request to ensure members have accesses to health care services related to COVID-19. Highlights of the requests (explained further in the Bulletin) includes:

• Travel insurance policies that cover sickness, accident, disability or death occurring during travel must cover related risks associated with COVID-19 (unless a specific exclusion applies).
• Health insurance issuers should have representatives and helplines readily available to provide accurate information to assist consumers with questions about coverage related to COVID-19.
• Emergency care must be covered without preauthorization and must be covered at the same cost sharing as if provided in-network.
• Health insurance issuers that provide telemedicine services are expected to provide such coverage for testing and treatment of COVID-19. Coverage may not be denied solely because it was provided through telemedicine. Further, issuers are required to provide telemedicine coverage on the same terms that the plan provides coverage for in-person services.

Employers with employees in Ohio should consult their carriers, as applicable, and be aware of the superintendent’s requests when addressing questions regarding health insurance coverage and COVID-19.

Bulletin 2020-02 »

Effective as of January 24, 2020, when an Ohio Cyber Reserve member is ordered by the governor to perform duties or training under certain state laws, such Cyber Reserve member has the same protections under USERRA as employees who are on active duty. As background, the Ohio legislature passed Ohio Senate Bill 52 in October 2019, creating a civilian cyber force within the Ohio National Guard to respond to cyberattacks.

Per USERRA, if employees take leave to serve in the uniformed services (or any state's organized militia), they are entitled to re-employment rights and continuation of health-care benefits. With this new legislation, Cyber Reserve members who perform duties under certain state laws as ordered by the governor have the same USERRA protections as employees who are on federal active duty.

Employers with employees in Ohio should be sure to comply with USERRA, including its requirements for continuation of health-care benefits, when administering leave related to a Cyber Reserve member fulfilling duties as ordered by the governor.

Senate Bill 52 »

On April 29, 2019, Director Froment released Bulletin 2019-02, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2020, as long as the transitional policy ends by December 31, 2020.

As background, on March 25, 2019, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Ohio and allows the issuer to renew these non-ACA compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Bulletin 2019-02 »

On Oct. 24, 2018, Director Froment released Bulletin 2018-05 to remind carriers and producers that issue policies in Ohio of the state insurance requirements for short-term health insurance. This bulletin was intended to remind carriers doing business in the state that state law isn’t preempted regarding short-term health insurance and, thus, carriers doing business in Ohio must continue to comply with state law.

As background, the federal government issued a rule in August 2018 that extended the initial contract term of short-term policies issued on or after Oct. 2, 2018, to be no more than 12 months while limiting renewals or extension of such policies to no more than 36 months. Like the federal rule, Ohio law limits a short-term policy to a term that is less than 12 months. Moreover, in Ohio, short-term policies are subject to state coverage mandates.

A non-exhaustive list of requirements and coverages applicable to short-term, limited-duration policies includes:

• Internal and external reviews
• Required provider network disclosures for consumers
• Coverage for mammography screenings
• Coverage for autism spectrum disorder

If the short-term, limited-duration policy offers family coverage, additional coverage mandates may apply, including but not limited to coverage for newborn children.

This bulletin was for informational purposes only and employers need not take any action at this time. The intent was to remind carriers that Ohio insurance law continues to apply to short-term health insurance, and carriers must factor in Ohio policies before issuing a product in response to the federal guidelines.

Bulletin 2018-05 »