Tuesday, January 24, 2012
OKLAHOMA CITY –Oklahoma Insurance Commissioner John D. Doak this afternoon praised a policy decision by the Oklahoma High Risk Pool that effectively closes any remaining gap in child-only health insurance coverage for Oklahomans.
“We’ve worked for a year to address this issue and a complete solution is coming together,” Doak said.
The Board of Directors of the Oklahoma Health Insurance High Risk Pool (OHRP) officially adopted a policy to waive rules requiring parents or guardians to show that the child was denied insurance by at least two carriers on the private market before applying for coverage under the OHRP. The board also voted to insure ill and premature infants immediately rather than make the parents endure a previously enforced one-year waiting period on pre-existing conditions before applying to insure the child. The moves permit immediate coverage through the High Risk Pool of all infants under age 1, whether healthy or sick.
The meeting was held at the Oklahoma Insurance Department, where the OHRP board convenes to conduct business.
Commissioner Doak and Dwight D. Herron, board chairman of the OHRP, agreed the High Risk Pool provides a crucial piece to the puzzle that child-only health insurance has become.
“For too long, health insurance coverage through the Oklahoma High Risk Pool has unintentionally been one of Oklahoma’s best-kept secrets,” Herron said. “The problem we face in Oklahoma is not the absence of health insurance coverage for children, but rather a lack of awareness as to what is currently available.
“We must do a better job of getting the word out to people, and I commend Commissioner Doak and the Oklahoma Insurance Department for working with us as we make the Oklahoma High Risk Pool more accessible and more visible to families seeking insurance in Oklahoma.”
Since taking office in January 2011, Commissioner Doak and his administration have worked to close a child-only insurance gap created by President Obama’s federal health reforms.
The child-only insurance market collapsed virtually nationwide in mid-2010. New federal health insurance mandates under the Patient Protection and Affordable Care Act and rules issued by the Obama administration and the U.S. Department of Health and Human Services prompted many carriers to withdraw from the sale of new individual insurance policies for children under age 19. No insured child lost coverage and insurance was still available to children through family plans, but in Oklahoma and 16 other states parents and guardians could no longer buy new insurance to cover only an individual child. In an additional 22 states, some but not all insurance companies withdrew from the child-only market.
New rules intended to restart the child-only market for Oklahoma were passed during the 2011 legislative session. A special open enrollment period was scheduled for September and October last year, but no insurers returned to the market. Companies were willing to resume selling new health insurance for Oklahoma children ages 1 to 18, but remained reluctant to cover infants under age 1.
An emergency rule crafted by Doak and the Insurance Department and signed in December by Gov. Mary Fallin restarted the sale of child-only private insurance policies for Oklahomans ages 1 to 18. A special open enrollment period is ongoing throughout January and February and the state’s two largest health insurers, Blue Cross Blue Shield and CommuityCare, have reentered the market. A regular open enrollment period will be held in June and July this year, and in each subsequent June and July.
The emergency rule addressed the lack of health coverage for the vast majority of families interested in child-only policies, but answering the needs of some infants remained. Today, the OHRP officially filled that gap by accepting sick children immediately and no longer requiring parents of infants to fruitlessly apply at least twice for coverage that isn’t being sold before seeking coverage from the High Risk Pool.
“Health insurance is now available for children under age 1 through one of three sources: SoonerCare for those who economically qualify; the Oklahoma Temporary High Risk Pool; and the Oklahoma Health Insurance High Risk Pool,” Herron said. “Enrollment requirements, benefits and premium rates vary between the three, but at least one coverage option is now available for all children regardless of their age or current health.”
Patti Davis, executive vice president of the Oklahoma Hospital Association, praised the new OHRP enrollment policies.
“We’re delighted that the Oklahoma High Risk Pool stepped up to provide coverage for the smallest and youngest Oklahoma citizens,” Davis said. “This move enables uninsured, hard-working, middle-class families to secure coverage for their babies and possibly avoid financial devastation if their baby is born with serious health issues.
“On behalf of Oklahoma hospitals that provide care for these infants, we are extremely pleased that this coverage can begin as soon as possible.”
Doak added that the Oklahoma Health Insurance High Risk Pool is not a government-funded program. While the OHRP was established by statute and is governed by its appointed board of directors, coverage is funded through a combination of premiums paid by enrolled policyholders and assessments paid into the pool by Oklahoma’s private insurance companies. Coverage is not subsidized by tax dollars.
The OHRP typically insures those whose preexisting medical conditions make it impossible or unaffordable to find insurance on the private market. Blue Cross and Blue Shield is contracted to manage the system.
“The High Risk Pool is an effective way, privately funded way to address these complex circumstances,” Doak said. “Those who prove difficult to insure otherwise are enrolled in a system that spreads the risk over all carriers in the state rather than a single company.”
“It took a lot of time, effort and cooperation to reach this point,” Doak added. “But we are pleased to say that when it comes to health insurance in Oklahoma, options exist for every child of any age.”
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About the Oklahoma Insurance Department
The Oklahoma Insurance Department, an agency of the State of Oklahoma, is responsible for the education and protection of the insurance-buying public and for oversight of the insurance industry in the state.