State RegulationsOH specificDifficulty 2/5
During her Medicare supplement open-enrollment period, an Akron applicant with diabetes and a recent hospital stay applies for coverage. Under OAC 3901-8-08(N)(1), the issuer may do which of the following?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
OAC 3901-8-08(N)(1) forbids an issuer, for applications submitted during the open-enrollment period, to deny or condition coverage or discriminate in pricing because of health status, claims experience, or medical condition. All plans the issuer then makes available must be offered without regard to age as well. The Akron applicant's diabetes and hospital stay therefore cannot affect underwriting, plan access, or premium, and the issuer's only lawful course is to offer its plans on the same basis as any other open enrollee.
Why the other options are wrong
- A) Denying the application for medical condition is precisely what the open-enrollment rule prohibits during the 6-month window.
- B) Price discrimination based on health status or claims experience is barred for open-enrollment applicants.
- D) The issuer must offer all plans it makes available during open enrollment; it may not steer the applicant to one plan of its choosing.
Memory hook
During open enrollment, health history is off the table — no denials, no surcharges, no steering.