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03.23.20   |   COVID-19, Insights

Health Insurance Update: Flexibility for Ohio Employees and Employers During COVID-19

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On March 20, 2020, the Superintendent of Insurance ordered and directed all insurers to comply with the following requirements until the expiration of the state of emergency declared by Ohio Governor Mike DeWine due to the COVID-19 pandemic:

Employee Eligibility: Insurers must permit employers to continue covering employees under group policies even if the employee would otherwise be ineligible due to a decrease in hours worked per week. Insurers are required to permit employers to continue providing coverage to employees under group policies regardless of any “actively at work” or similar eligibility requirements in policy. 

  • Thus, an employee who previously worked 40 hours per week and was eligible for the employer’s group health insurance can work for only 5 hours a week during the COVID-19 emergency declaration and will remain eligible for group insurance coverage through their employer even if the hour reduction would normally prohibit eligibility under the policy. 
  • Employers that do not currently have sufficient work, but are intending to temporarily lay off their employees for later recall may be able to place employees on a furlough or “leave of absence” status due to temporary lack of work that will permit the employer to keep the employee on the group health plan instead of enrolling them in COBRA.
    • Note, however, this must be consistent with your policy (including any stop loss coverage). Be sure to review the terms of your applicable plan documents regarding eligibility for coverage during furloughs or “leaves of absence” and consult your insurance broker and/or attorney with questions.
    • If the group health plan permits laid-off or furloughed employees to continue participation in the group health plan for the determined period, there should be no COBRA-qualifying event because the loss of coverage has not yet occurred.
    • If an employer decides to offer a furlough or leave of absence to employees, it must do so on a nondiscriminatory basis and without regard to protected factors; and the employer should establish it for a pre-determined length of time.
    • When the leave of absence ends, if it is not due to recall by the employer, but rather due to termination, a notice of COBRA eligibility must be offered to the employee.

Premiums: Insurers are prohibited from increasing premium rates based on a group’s decreased enrollment or participation due to COVID-19. All insurers are to give their insureds the option of deferring premium payments coming due, interest free, for up to 60 calendar days from each original premium due date.

Continuation Coverage: 

  • For employers that employ 20 or more employees: so long as one person remains actively employed, eligible employees may elect to continue coverage under COBRA pursuant to the normal notice and election procedures.
    • Employers may elect (but have no obligation) to pay for some portion of the employee’s COBRA premiums. 
  • For employers that employ fewer than 20 employees, as long as one person remains actively employed and enrolled in the plan, eligible employees may elect to continue coverage pursuant to state continuation coverage for up to 12 months. Insurers should work with employers to ensure employees receive the appropriate notice of these options. 
  • 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.

Special Enrollment: Employees who lose coverage are eligible for a special enrollment period to enroll in new coverage. Premium subsidies may be available for those that qualify by purchasing plans on the federal exchange. Plans sold on the federal exchange are effective the first day of the next month after enrollment.  For those purchasing policies sold outside of the federal exchange, insurers shall waive normal special enrollment procedures and allow applicants to obtain coverage effective the day after their loss of employment. 

Please contact us should you have any questions in regard to the Superintendent’s order.

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