By Robert R. Sparks
The Governors and the Departments of Insurance in Ohio and Kentucky have recently taken steps to protect insureds – both individuals and businesses – during the COVID-19 pandemic. These actions follow the states of emergency declared by the governors of both Ohio and Kentucky on March 9, 2020, in response to the pandemic.
In response to the Governor’s Order declaring a State of Emergency, the Ohio Department issued a series of bulletins providing guidance and direction to insurance companies during the emergency:
- Access to Coverage. This Bulletin seeks to ensure that individuals “have access to needed health care services to test for and treat COVID-19 by promoting access to coverage.” This guidance from the Department instructs insurers: (1) to provide “helpful and accurate information” to insureds; (2) to cover emergency care “without preauthorization and . . . at the same cost sharing level as if provided in-network”; (3) to ensure that their networks are “adequate to handle testing and care for COVID-19” and, if they aren’t, to “provide access to out-of-network providers at in-network cost sharing”; and, (4) to evaluate ways to provide access “to services for testing or treatment of COVID-19.”
- Insurance Coverage Flexibility. This Bulletin orders insurers to allow employers to continue covering employees even if their hours drop below the minimum required by the policy. It also requires insurance companies to provide a 60-day grace period, interest free, to pay premiums on health insurance policies. The Bulletin also includes orders relating to continuation coverage and a special enrollment period for individuals that have lost coverage.
- Expired Driver Licenses. This Bulletin prohibits insurers from cancelling or refusing to renew and automobile insurance policy, or denying a claim, “solely because the driver license of a named insured or other covered family member has expired since the Governor’s declaration of emergency.” The license must have expired after the Governor declared a State of Emergency on March 9. This Bulletin is in force until 30 days after the emergency declaration is lifted.
- Premium Grace Period. This Bulletin requires insurers to provide their insureds with “at least a 60-day grace period to pay insurance premiums,” or comply with a policy provision that imposes a time limit. This grace period applies to insurers providing property and casualty, life, and long term care insurance policies in the State of Ohio. This action is intended to protect insureds from having their insurance policies cancelled for nonpayment of premium during the state of emergency. This is not a premium waiver. The Department also encouraged insurers to “offer payment accommodations, such as allowing consumers to defer payments at no cost, extending payment due dates, or waiving late or reinstatement fees, where consumers are unable to make timely payments of premium or fees due to COVID-19-related disruptions.”
On March 9, 2020, Governor Beshear also declared a State of Emergency Relating to Insurance. The Governor specifically ordered insurance companies to “waive all cost-sharing including copayments, coinsurance, and deductibles for screening and testing for COVID-19.” This includes charges for testing – not treatment – by hospital, emergency department, urgent care, provider office visits, lab testing, telehealth, and any immunizations that may be made available later. The Governor’s Order also requires health insurance companies to ensure that their networks “are adequate to handle an increase in the need for health care services, including by offering access to out-of-network services where appropriate.”
The Kentucky Department of Insurance has issued guidance effective during the State of Emergency that protects individuals and businesses that have been forced to rely on delivery when providing essential services. For companies permitted to remain open and which are now providing delivery services, insurance companies cannot rely on exclusions typically found in personal automobile policies that prohibit vehicles from being used for commercial purposes. This guidance protects those employees that are providing delivery services temporarily using their own insured personal vehicles.
We expect additional orders and guidance to be issued by the Ohio and Kentucky Departments of Insurance as the need arises. We will keep you updated on any new guidance.
Rob Sparks concentrates his practice in civil trial and appellate practice in the areas of consumer class actions, consumer fraud, securities and investment fraud, corporate governance, insurance litigation, and insurance and brokerage matters. He has represented people and businesses harmed by fraud and unscrupulous business practices in state and federal courts throughout the United States.