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It's a wrap: Ohio MCO open enrollment 2016


Many within the workers’ compensation industry know that Ohio’s system is unique. In fact, even here at Sedgwick, we frequently hear, “that’s a state of Ohio situation.” The good news is that Sedgwick’s Ohio team of nearly 400 colleagues within the CompManagement Partner Companies fully understands the unique nuances within the Ohio market.

First off, it’s a monopolistic state where the Ohio Bureau of Workers’ Compensation (BWC) is the insurance carrier for more than 225,000 employers in the state fund. About two-thirds of Ohio’s workforce is covered by BWC and the remainder is covered through self-insured programs administered by large employers.

It is also unique in that managed care services are provided directly by 15 different managed care organizations (MCOs) where 100,000 new injuries and 2.5 million bills are processed each year; and 300,000 active claims are being managed at any point in time.

While employers in Ohio contract individually and directly with third party administrators for workers’ compensation claims administration, a managed care organization (MCO) has just one contract, which is with BWC. MCOs focus on providing return-to-work and managed care services to help injured employees get back on the job as quickly and safely as possible.

Perhaps the most distinctive aspect for Ohio employers is the MCO selection process. They can only change MCOs during a short, four-week period during the month of May every other year. The most recent open enrollment period took place last month and the transition for employers that selected a new MCO will occur in early July.

For the 2016 open enrollment period, we are proud to say that our Ohio MCO, CompManagement Health Systems (CHS), led the industry in both the net premium increase and the number of new claims:

  • Gained more than $19 million in net premium (more than 70% better than our nearest competitor)
  • Added over 7,000 new claims

MCOs that provide medical management with a return-to-work focus can help ensure timely and cost-effective claim resolution. They can also offer additional advantages for employers and injured employees by consistently examining treatment trends and scrutinizing medical expenses.

With 19 years of experience, CHS has the expertise to help clients handle the complex medical issues involved in Ohio workers’ compensation claims. We help our customers reduce lost time and medical costs – and ultimately gain more control over their premiums.

We would like to hear from you and answer any questions you might have regarding the nuances of the workers’ compensation and managed care process for state fund employers in Ohio. Please feel free to leave your questions or comments here. 

Quinn Guist, President, CH

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