Open enrollment: expensive option for high risk individual to obtain coverage

Each year Ohio's health insuring corporations must offer one open enrollment period for most Ohioans within the service area of that health plan.  During this period, the health plan cannot reject an application for coverage based on health status, unless the applicant is "confined to a hospital, skilled nursing facility, or health-care facility because of chronic illness, permanent injury, or other infirmity that would cause economic impairment at the time application for coverage is made" (Source: "Legal Notice: HMO Health Ohio," The Columbus Dispatch, May 17, 2008, p. A5).

There may be a 12 month waiting period for organ and tissue transplant services and procedures, unless the applicant can show prior creditable coverage.  This enrollment period is alos not open to people who are covered by Medicare, by any employee-sponsored plan at the time of open enrollment, or through COBRA benefit extension rights.

The rates charged during the open enrollment period are very expensive, reflecting the poor health status of those who need to apply for coverage through the open enrollment option.  These high insurance costs for people with prexisting conditions is one reason why Ohio policymakers have explored the possibility of creating a high risk pool, including a study done by the Ohio Department of Insurance in 2005.  It is also a reason why Ohio's State Coverage Institute team is exploring health reform options to make coverage more affordable.  ODI is posting all of the information associated with Governor Strickland's health reform discussions on a website, open to all to review.

All health plans are required to post legal notices in Ohio newspapers announcing their open enrollment period.  HMO Health Ohio posted such a notice in the May 17, 2008 edition of The Columbus Dispatch.  Its open enrollment period runs from June 1, 2008 to June 30, 2008, with coverage becoming effective on October 1, 2008.

According to this notice, HMO Health Ohio's quarterly rates for people are the following:

Age                         Single                             Two Person                                  Family

Under 30               $2,944,20                        $5,883.24                                    $7,943.64

30-39                   $3,869.07                         $7,738.22                                    $10,445.94

40-49                   $5,138.19                         $10,276.38                                  $12,873.11

50-59                   $7,445.25                         $14,885.34                                  $20,095.47

60+                      $10,379.16                       $20,753.16                                  $28,018.56

The Ohio Department of Insurance oversees this open enrollment requirement.  Below is the list of open enrollment periods for all Ohio health plans required to participate:

Plan Name                                       Expected Dates                                      Contact Number

Paramount Health Care                    January 1 - January 30                            (800) 462-3589
The Health Plan                               March 1 - March 30                                 (800) 624-6961
SummaCare, Inc.                             March 1 - March 30                                 (800) 996-8701
Super Med HMO                               June 1 - June 30                                     (800) 522-2066
HMO Health Ohio                             June 1 - June 30                                     (800) 522-2066
HealthAssurance HMO                      July 1 - July 30                                        (800) 788-6503
United HealthCare of Ohio, Inc.        August 1 - August 30                               (800) 811-5981
Humana/ChoiceCare                        August - August 30                                 (800) 448-6262
Anthem Blue Cross & Blue Shield       September 1 - September 30                   (800) 313-9634
Connecticut General Life Insurance   September 1 - September 30                   (800) 456-6575
Kaiser Permanente                           October 1 - October 30                           (800) 467-6552
AultCare HMO                                  October - October 30                              (800) 344-8858
Aetna Health Inc. (PA)                     December 1 - December 30                       (888) 438-8581