Open Enrollment

SummaCare’s Open Enrollment period for the Summa Open Enrollment Plan begins January 1 and remains open until our quota is reached.  Online application process and eligibility rules, including requirements regarding Cobra health coverage and pre-existing coverage, are explained below.  Chose SummaCare for coverage today.  

Accepting New Non-Federally Eligible Members: Yes

Application Process

Applications may be received online or by mail. A SummaCare representative will respond to a telephone call within two business days and a completed application within five business days.

Online:

• View Rates, Get a Quote and Apply Online
• Basic Indemnity Open Enrollment Policy
• Basic Indemnity Open Enrollment Plan 
• Standard PPO Open Enrollment Policy
• PPO Open Enrollment Plan 
• Open Enrollment Comparison Chart

By Mail:
Download and print the application. Submit completed application to:

Summa Insurance Company
10 North Main Street
Akron, Ohio  44308
Attention:  Open Enrollment

• Open Enrollment Application (pdf)

To request a paper copy of the application, call 888-585-6538.

Eligibility

You may apply for a Summa Insurance Company Open Enrollment Plan if you are a Federally Eligible Individual or a Non-Federally Eligible Individual.

Ohio law requires us to accept a certain number of individuals for open enrollment coverage without regard to health status. If you qualify as a Federally Eligible Individual (FEI), your coverage will be effective immediately without any pre-existing condition exclusion period. If you do not qualify as a FEI, you may apply for non-FEI open enrollment coverage.

You are a Federally Eligible Individual if you meet all of the following conditions:

1. You have had health coverage for at least 18 months without a break in coverage greater than 63 days.
2. Your most recent health coverage was under a group health plan, governmental plan or church plan.
3. You are not eligible for coverage under any of the following plans:
   1. A group health plan
   2. Medicare
   3. Medicaid
4. You do not have any other health coverage.
5. Your most recent health coverage was not terminated because of nonpayment of premiums or fraud.
6. If you had been offered the option to continue coverage under COBRA or a state continuation plan, you both elected and exhausted the continuation coverage.

You may need to submit proof of previous creditable coverage.

You are a Non-Federally Eligible Individual if you meet all of the following conditions:

1. You are not applying for coverage as an employee of an employer, member of an association or member of any other group.
2. You do not have any other health coverage and are not eligible to be covered under any private or public health benefit plans including the following:
   1. Medicare or Medicare supplement policy
   2. Medicaid
   3. Any COBRA or state continuation coverage plan
   4. Other health benefits arrangement

We are not required to accept applicants who, at the time of enrollment, are confined to a healthcare facility due to chronic illness or permanent injury. As a Non-Federally Eligible Individual, coverage may be limited for pre-existing conditions for the first 12 months. However, we will credit time you were covered under a recent previous health plan.

Pre-Existing Condition Limitation
(Applies to Non-Federally Eligible Individuals):

A pre-existing condition is any medical condition that has been diagnosed or treated within six months before your effective date of coverage under your Open Enrollment Plan. Pre-existing condition exclusions shall not exclude or limit coverage beyond 12 months from your effective date of coverage.  We will shorten the time period for pre-existing conditions by the amount of time you or your dependent was covered under a previous policy or plan if your coverage starts by midnight of the 63rd day after another policy or plan has ended.

 

Payment

Please complete the Auto Debit Form which allows for transfer of the monthly premium from either your debit card or checking account. You will be notified within five business days after receipt of a completed application of your effective date of coverage.