The Return of Open Enrollment

What this means for you, your company and your employees
By Deborah Rutledge

It’s open season for employers in Ohio to change— or, if a new employer, select for the first time—who will manage the medical side of their workers’ compensation activity.

Called Open Enrollment, this period occurs every two years and refers to the brief window of time in which employers can choose or change their own Managed Care Organization (MCOs) to handle the medical care and oversight for employees who are injured on the job.

This time Open Enrollment will run from April 30 to May 25.

All employers are required by the Ohio Bureau of Workers’ Compensation to choose one of 13 MCOs the BWC partners with to manage their medical workers’ compensation claims. MCOs are paid not directly by employers, but by the Ohio BWC through premiums employers pay to its state fund.

The Ohio BWC was established in 1912 and now provides workers’ compensation insurance to 242,000 public and private Ohio employers, says Melissa Vince, public relations manager of the Ohio BWC. It is the largest state-run insurance system in the country, employing 1,800 people and overseeing assets of approximately $29 billion, according to the BWC.

Ohio is one of just a few monopolistic states for workers’ compensation, meaning in those states private insurance companies are not allowed to offer workers’ compensation coverage. Instead, it must be provided exclusively by that state’s program.

Each state has its own laws regarding workers’ comp, but in Ohio employers must follow the Bureau of Workers’ Compensation (BWC) coverage requirements through its state fund that provides cash benefits and/or medical care for employees injured at work. Ohio employers must provide coverage to employees in the event of a workplace injury.

There are exceptions, Vince adds.

“While BWC is the exclusive provider of workers’ comp coverage, companies can apply to self-insure,” she says. “They do have to meet specific requirements to be approved, [but] about 1,175 Ohio employers are self-insured.”

All employers that pay into the State Fund are required to have an MCO, which coordinates health care services for injured workers. To help with the selection, the BWC provides a report card on the MCOs, but many employers recommend calling the MCOs to get an idea of the service levels and responsiveness.

“The BWC creates the MCO report card as an objective source of information to help employers evaluate the performance of the MCOs,” Vince says. “The decision is of course the employer’s to make.”

Since staffing, programming and special reporting vary by MCO, employers also suggest asking what the MCO does differently than the others. Service fees are not a factor to worry about since everything is covered in the premiums employers pay to the BWC.

For its part promoting workplace safety, the Ohio BWC offers safety intervention grants to employers like fire departments with its Firefighter Exposure to Environmental Elements Grant (FEEEG) Program. The program aims to minimize exposure to dangerous environmental elements.

Through it, eligible Ohio employers may purchase the protective items such as diesel exhaust systems, extractors-washing machines for turnout gear, hoods with barrier protection and washable structural firefighter gloves.

The popular FEEEG Program is available only to Ohio firefighter employers, but eligible employers may receive up to $15,000 for the program’s duration.

The BWC’s work in tackling the opioid crisis has garnered international notice and awards, Vince says.

The International Association of Industrial Accident Boards and Commissions (IAIABC) named BWC’s pharmacy department the winner of its second annual Innovation Award for its contest entry, “Saving Lives – Building a Model Pharmacy Program Amid a Deadly Epidemic.”

“Saving Lives” summarizes BWC’s work since 2011 to reduce opioid abuse and excessive prescribing of the painkillers while building a pharmacy program that’s recognized as a leader in the industry today. Led by former Pharmacy Director John Hanna, the department found 8,029 injured workers dependent on opioids in 2011 and reduced that number by nearly half to 4,101 by the end of 2016.