130th Ohio General Assembly
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S. B. No. 272  As Introduced
As Introduced

126th General Assembly
Regular Session
2005-2006
S. B. No. 272


Senators Wachtmann, Stivers 



A BILL
To amend sections 1731.05, 1739.05, 1751.17, 1751.18, 3923.57, 3924.08, 3924.09, 3924.11, and 3924.73; to amend, for the purpose of adopting a new section number as indicated in parentheses, section 3923.83 (3923.96); to enact new section 3923.83 and sections 3923.81, 3923.82, and 3923.84 to 3923.93; and to repeal sections 1751.15, 3923.58, 3923.581, and 3923.59 of the Revised Code to establish and operate the Ohio Health Insurance Risk Pool and repeal existing open enrollment provisions.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1731.05, 1739.05, 1751.17, 1751.18, 3923.57, 3924.08, 3924.09, 3924.11, and 3924.73 be amended, section 3923.83 (3923.96) be amended for the purpose of adopting a new section number as indicated in parentheses, and new section 3923.83 and sections 3923.81, 3923.82, 3923.84, 3923.85, 3923.86, 3923.87, 3923.88, 3923.89, 3923.90, 3923.91, 3923.92, and 3923.93 of the Revised Code be enacted to read as follows:
Sec. 1731.05.  If a qualified alliance, or an alliance that, based upon evidence of interest satisfactory to the superintendent of insurance, will be a qualified alliance within a reasonable time, submits a request for a proposal on a health benefit plan to at least three insurers and does not receive at least one reasonably responsive proposal within ninety days from the date the last such request is submitted, the superintendent, at the request of such alliance, may require that insurers offer proposals to such alliance for health benefit plans for the small employers within such alliance. Such proposals shall include such coverage and benefits for such premiums, as shall take into account the functions provided by the alliance and the economies of scale, and have other terms and provisions as are approved by the superintendent, consistent with the purposes and standards set forth in section 1731.02 of the Revised Code. In making the determination as to which insurers shall be asked to submit proposals under this section, the superintendent shall apply the standards set forth in division (G)(4)(a) of section 3924.11 of the Revised Code consider the insurer's market presence, experience in the individual market and in rating and underwriting individual plans, and financial stability. Any insurer that does not submit a proposal when required to do so by the superintendent hereunder, shall be deemed to be in violation of section 3901.20 of the Revised Code and shall be subject to all of the provisions of section 3901.22 of the Revised Code, including division (D)(1) of section 3901.22 of the Revised Code as if it provided that the superintendent may suspend or revoke an insurer's license to engage in the business of insurance.
Nothing in this section shall be construed as requiring an insurer to enter into an agreement with an alliance under contractual terms that are not acceptable to the insurer or to authorize the superintendent to require an insurer to enter into an agreement with an alliance under contractual terms that are not acceptable to the insurer.
This section applies beginning eighteen months after its effective date.
Sec. 1739.05.  (A) A multiple employer welfare arrangement that is created pursuant to sections 1739.01 to 1739.22 of the Revised Code and that operates a group self-insurance program may be established only if any of the following applies:
(1) The arrangement has and maintains a minimum enrollment of three hundred employees of two or more employers.
(2) The arrangement has and maintains a minimum enrollment of three hundred self-employed individuals.
(3) The arrangement has and maintains a minimum enrollment of three hundred employees or self-employed individuals in any combination of divisions (A)(1) and (2) of this section.
(B) A multiple employer welfare arrangement that is created pursuant to sections 1739.01 to 1739.22 of the Revised Code and that operates a group self-insurance program shall comply with all laws applicable to self-funded programs in this state, including sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381 to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, 3924.031, 3924.032, and 3924.27 of the Revised Code.
(C) A multiple employer welfare arrangement created pursuant to sections 1739.01 to 1739.22 of the Revised Code shall solicit enrollments only through agents or solicitors licensed pursuant to Chapter 3905. of the Revised Code to sell or solicit sickness and accident insurance.
(D) A multiple employer welfare arrangement created pursuant to sections 1739.01 to 1739.22 of the Revised Code shall provide benefits only to individuals who are members, employees of members, or the dependents of members or employees, or are eligible for continuation of coverage under section 1751.53 or 3923.38 of the Revised Code or under Title X of the "Consolidated Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29 U.S.C.A. 1161, as amended.
Sec. 1751.17.  (A) As used in this section, "nongroup contract" means a contract issued by a health insuring corporation to an individual who makes direct application for coverage under the contract and who, if required by the health insuring corporation, submits to medical underwriting. "Nongroup contract" does not include group conversion coverage, coverage obtained through open enrollment, or coverage issued on the basis of membership in a group.
(B) Except as provided in division (C) of this section, every nongroup contract that is issued by a health insuring corporation and that makes available basic health care services shall provide an option for conversion to a contract issued on a direct-payment basis to an enrollee covered by the nongroup contract. The option for conversion shall be available:
(1) Upon the death of the subscriber, to the surviving spouse with respect to the spouse or dependents who were then covered by the nongroup contract;
(2) Upon the divorce, dissolution, or annulment of the marriage of the subscriber, to the divorced spouse, or, in the event of annulment, to the former spouse of the subscriber;
(3) To a child solely with respect to the child, upon the child's attaining the limiting age of coverage under the nongroup contract while covered as a dependent under the contract.
(C) The direct payment contract offered pursuant to division (B) of this section shall not be made available to an enrollee if any of the following applies:
(1) The enrollee is, or is eligible to be, covered for benefits at least comparable to the nongroup contract under any of the following:
(a) The medical assistance program under Chapter 5111. of the Revised Code;
(b) Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended;
(c) Any act of congress or law under this or any other state of the United States providing coverage at least comparable to the benefits offered under division (C)(1)(a) or (b) of this section.
(2) The nongroup contract under which the enrollee was covered was terminated due to nonpayment of a premium rate.
(3) The enrollee is eligible for group coverage provided by, or available through, an employer or association and the group coverage provides benefits comparable to the benefits provided under a direct payment contract.
(D) The direct payment contract offered pursuant to division (B) of this section shall provide benefits that are at least comparable to the benefits provided by the nongroup contract under which the enrollee was covered at the time of the occurrence of any of the events set forth in division (B) of this section. The coverage provided under the direct payment contract shall be continuous, provided that the enrollee makes the required premium rate payment within the thirty-day period immediately following the occurrence of the event, and may be terminated for nonpayment of any required premium rate payment.
(E) The evidence of coverage of every nongroup contract shall contain notice that an option for conversion to a contract issued on a direct-payment basis is available, in accordance with this section, to any enrollee covered by the contract.
(F) Benefits otherwise payable to an enrollee under a direct payment contract shall be reduced by the amount of any benefits available to the enrollee under any applicable group health insuring corporation contract or group sickness and accident insurance policy.
(G) Nothing in this section shall be construed as requiring a health insuring corporation to offer nongroup contracts.
(H) This section does not apply to any nongroup contract offering only supplemental health care services or specialty health care services.
Sec. 1751.18.  (A)(1) No health insuring corporation shall cancel or fail to renew the coverage of a subscriber or enrollee because of any health status-related factor in relation to the subscriber or enrollee, the subscriber's or enrollee's requirements for health care services, or for any other reason designated under rules adopted by the superintendent of insurance.
(2) Unless otherwise required by state or federal law, no health insuring corporation, or health care facility or provider through which the health insuring corporation has made arrangements to provide health care services, shall discriminate against any individual with regard to enrollment, disenrollment, or the quality of health care services rendered, on the basis of the individual's race, color, sex, age, religion, or status as a recipient of medicare or medical assistance under Title XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended, or any health status-related factor in relation to the individual. However, a health insuring corporation shall not be required to accept a recipient of medicare or medical assistance, if an agreement has not been reached on appropriate payment mechanisms between the health insuring corporation and the governmental agency administering these programs. Further, except during a period of open enrollment under section 1751.15 of the Revised Code, a health insuring corporation may reject an applicant for nongroup enrollment on the basis of any health status-related factor in relation to the applicant.
(B) A health insuring corporation may cancel or decide not to renew the coverage of an enrollee if the enrollee has performed an act or practice that constitutes fraud or intentional misrepresentation of material fact under the terms of the coverage and if the cancellation or nonrenewal is not based, either directly or indirectly, on any health status-related factor in relation to the enrollee.
(C) An enrollee may appeal any action or decision of a health insuring corporation taken pursuant to section 2742(b) to (e) of the "Health Insurance Portability and Accountability Act of 1996," Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg-42, as amended. To appeal, the enrollee may submit a written complaint to the health insuring corporation pursuant to section 1751.19 of the Revised Code. The enrollee may, within thirty days after receiving a written response from the health insuring corporation, appeal the health insuring corporation's action or decision to the superintendent.
(D) As used in this section, "health status-related factor" means any of the following:
(1) Health status;
(2) Medical condition, including both physical and mental illnesses;
(3) Claims experience;
(4) Receipt of health care;
(5) Medical history;
(6) Genetic information;
(7) Evidence of insurability, including conditions arising out of acts of domestic violence;
(8) Disability.
Sec. 3923.57.  Notwithstanding any provision of this chapter, every individual policy of sickness and accident insurance that is delivered, issued for delivery, or renewed in this state is subject to the following conditions, as applicable:
(A) Pre-existing conditions provisions shall not exclude or limit coverage for a period beyond twelve months following the policyholder's effective date of coverage and may only relate to conditions during the six months immediately preceding the effective date of coverage.
(B) In determining whether a pre-existing conditions provision applies to a policyholder or dependent, each policy shall credit the time the policyholder or dependent was covered under a previous policy, contract, or plan if the previous coverage was continuous to a date not more than thirty days prior to the effective date of the new coverage, exclusive of any applicable service waiting period under the policy.
(C)(1) Except as otherwise provided in division (C) of this section, an insurer that provides an individual sickness and accident insurance policy to an individual shall renew or continue in force such coverage at the option of the individual.
(2) An insurer may nonrenew or discontinue coverage of an individual in the individual market based only on one or more of the following reasons:
(a) The individual failed to pay premiums or contributions in accordance with the terms of the policy or the insurer has not received timely premium payments.
(b) The individual performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the policy.
(c) The insurer is ceasing to offer coverage in the individual market in accordance with division (D) of this section and the applicable laws of this state.
(d) If the insurer offers coverage in the market through a network plan, the individual no longer resides, lives, or works in the service area, or in an area for which the insurer is authorized to do business; provided, however, that such coverage is terminated uniformly without regard to any health status-related factor of covered individuals.
(e) If the coverage is made available in the individual market only through one or more bona fide associations, the membership of the individual in the association, on the basis of which the coverage is provided, ceases; provided, however, that such coverage is terminated under division (C)(2)(e) of this section uniformly without regard to any health status-related factor of covered individuals.
An insurer offering coverage to individuals solely through membership in a bona fide association shall not be deemed, by virtue of that offering, to be in the individual market for purposes of sections 3923.58 and 3923.581 of the Revised Code. Such an insurer shall not be required to accept applicants for coverage in the individual market pursuant to sections 3923.58 and 3923.581 of the Revised Code unless the insurer also offers coverage to individuals other than through bona fide associations.
(3) An insurer may cancel or decide not to renew the coverage of a dependent of an individual if the dependent has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage and if the cancellation or nonrenewal is not based, either directly or indirectly, on any health status-related factor in relation to the dependent.
(D)(1) If an insurer decides to discontinue offering a particular type of health insurance coverage offered in the individual market, coverage of such type may be discontinued by the insurer if the insurer does all of the following:
(a) Provides notice to each individual provided coverage of this type in such market of the discontinuation at least ninety days prior to the date of the discontinuation of the coverage;
(b) Offers to each individual provided coverage of this type in such market, the option to purchase any other individual health insurance coverage currently being offered by the insurer for individuals in that market;
(c) In exercising the option to discontinue coverage of this type and in offering the option of coverage under division (D)(1)(b) of this section, acts uniformly without regard to any health status-related factor of covered individuals or of individuals who may become eligible for such coverage.
(2) If an insurer elects to discontinue offering all health insurance coverage in the individual market in this state, health insurance coverage may be discontinued by the insurer only if both of the following apply:
(a) The insurer provides notice to the department of insurance and to each individual of the discontinuation at least one hundred eighty days prior to the date of the expiration of the coverage.
(b) All health insurance delivered or issued for delivery in this state in such market is discontinued and coverage under that health insurance in that market is not renewed.
(3) In the event of a discontinuation under division (D)(2) of this section in the individual market, the insurer shall not provide for the issuance of any health insurance coverage in the market and this state during the five-year period beginning on the date of the discontinuation of the last health insurance coverage not so renewed.
(E) Notwithstanding divisions (C) and (D) of this section, an insurer may, at the time of coverage renewal, modify the health insurance coverage for a policy form offered to individuals in the individual market if the modification is consistent with the law of this state and effective on a uniform basis among all individuals with that policy form.
(F) Such policies are subject to sections 2743 and 2747 of the "Health Insurance Portability and Accountability Act of 1996," Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg-43 and 300gg-47, as amended.
(G) Sections 3924.031 and 3924.032 of the Revised Code shall apply to sickness and accident insurance policies offered in the individual market in the same manner as they apply to health benefit plans offered in the small employer market.
In accordance with 45 C.F.R. 148.102, divisions (C) to (G) of this section also apply to all group sickness and accident insurance policies that are not sold in connection with an employment-related group health plan and that provide more than short-term, limited duration coverage.
In applying divisions (C) to (G) of this section with respect to health insurance coverage that is made available by an insurer in the individual market to individuals only through one or more associations, the term "individual" includes the association of which the individual is a member.
For purposes of this section, any policy issued pursuant to division (C) of section 3923.13 of the Revised Code in connection with a public or private college or university student health insurance program is considered to be issued to a bona fide association.
As used in this section, "bona fide association" has the same meaning as in section 3924.03 of the Revised Code, and "health status-related factor" and "network plan" have the same meanings as in section 3924.031 of the Revised Code.
This section does not apply to any policy that provides coverage for specific diseases or accidents only, or to any hospital indemnity, medicare supplement, long-term care, disability income, one-time-limited-duration policy of no longer than six months, or other policy that offers only supplemental benefits.
Sec. 3923.81. As used in sections 3923.81 to 3923.93 of the Revised Code:
(A) "Benefit plan" means the coverage offered by the Ohio health insurance risk pool to eligible individuals.
(B) "COBRA continuation provision" has the same meaning as in section 733 of the federal "Employee Retirement Income Security Act of 1974," 29 U.S.C.A. 1001, et seq. "COBRA" means the "Consolidated Omnibus Budget Reconciliation Act of 1985," 99 P.L. 272.
(C) "Dependent" means any of the following:
(1) An unmarried child under nineteen years of age or resident spouse;
(2) A child who is a full-time student under twenty-five years of age and financially dependent upon the parent;
(3) A child over nineteen years of age for whom the parent is obligated to pay child support;
(4) A child of any age who is disabled and dependent on the parent.
(D) "Family member" means a parent, grandparent, brother, sister, or child of a dependent residing with the insured.
(E) "Health insurance" means a sickness and accident insurance policy, health insuring corporation policy, contract, or agreement, or any other individual or group health care policy, plan, contract, or agreement that pays for or furnishes health care services.
"Health insurance" does not include an individual or group policy, plan, contract, or agreement covering only accident, credit, dental, disability, long-term care, hospital indemnity, fixed indemnity, medicare supplement, specified disease, or vision care; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or a similar law; automobile medical-payment insurance; insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance; or an employer self-insured health benefit plan to the extent regulated by federal law.
(F) "Insured" means any individual who is a resident of this state and a beneficiary of the Ohio health insurance risk pool, including primary insureds, dependents, and family members.
(G) "Insurer" means any entity licensed or otherwise authorized to write health insurance in this state, any employer that funds and administers a self-insured employee health benefit plan subject to regulation by the federal "Employee Retirement Income Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended, and stop-loss and reinsurance carriers authorized to provide reinsurance or stop-loss coverage to insurers.
(H) "Physician" means any person, partnership, or professional corporation authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.
(I) "Plan of operation" means the articles, bylaws, and operating rules of the Ohio health insurance risk pool that are adopted by its board of directors.
(J) "Resident" means any of the following:
(1) An individual who has been legally domiciled in this state for a minimum of one year;
(2) An individual who is legally domiciled in this state on the date of application to the pool and who is eligible for enrollment in the pool as a result of the federal "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 1955, 42 U.S.C.A. 300gg, as amended;
(3) An individual who is legally domiciled in this state on the date of application to the pool and is eligible for the credit for health reinsurance costs under section 35 of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 35, as amended.
Sec. 3923.82. (A) There is hereby created a body corporate and politic to be known as the Ohio health insurance risk pool, which is deemed to be an instrumentality of the state and a public corporation. Any change in the name of the pool or the pool's plan of operation in no way impairs the obligations of any existing contract entered into under this chapter.
(B) A board of directors consisting of nine members appointed in accordance with divisions (C) and (D) of this section shall govern the pool.
(C) The superintendent of insurance shall appoint the following individuals as board members for staggered six-year terms:
(1) Two individuals affiliated with an insurer admitted and authorized to write health insurance in this state. One of these individuals shall represent domestic insurers.
(2) One member of the Ohio association of health underwriters who is licensed to sell insurance;
(3) One representative of the general public who is not employed by or affiliated with an insurer, hospital, or health care provider except through the maintenance of personal insurance policies, contracts, or plans, and who reasonably can be expected to qualify for a benefit plan;
(4) One individual representing health care providers, such as a physician or hospital administrator;
(5) Two representatives of the business community, one representing employers with five thousand or more employees and one representing employers with less than five thousand employees.
(D)(1) The chair of the committee of the house of representatives with jurisdiction over insurance issues shall appoint one committee member to the board for a term matching the member's term of office;
(2) The chair of the committee of the senate with jurisdiction over insurance issues shall appoint one committee member to the board for a term matching the member's term of office.
(E) If a vacancy occurs on the board, the superintendent or committee chair shall fill the vacancy for the duration of the former member's unexpired term in the same manner as the superintendent or committee chair filled the original appointment.
(F) The superintendent shall designate one of the individuals appointed in division (C) of this section to serve, at the pleasure of the superintendent, as chairperson of the board.
(G) The department of insurance shall pay members of the board two hundred dollars per meeting, plus travel expenses, from the department's general operating fund.
Sec. 3923.83. A board member of the Ohio health insurance risk pool is not liable, and no cause of action may be brought against the board member, for damages resulting from an act or omission of the board member taken in good faith in connection with the member's duties and responsibilities on the board.
Sec. 3923.84. (A)(1) The board of the Ohio health insurance risk pool shall submit a plan of operation for the Ohio health insurance risk pool to the superintendent of insurance within one hundred eighty days after the initial appointment of the board's last member pursuant to section 3923.82 of the Revised Code. The board shall design the plan of operation to assure the fair, reasonable, and equitable administration of the pool.
(2) The superintendent may adopt an interim plan of operation if the board fails to timely submit a plan. The interim plan of operation continues in effect until the board submits, and the superintendent approves, a plan of operation in accordance with this section.
(B) The plan of operation shall include provisions governing all of the following:
(1) Operation of the pool;
(2) Selection of an insurer or third-party administrator licensed under Chapter 3959. of the Revised Code using a competitive bidding process to administer the pool;
(3) Creation of a fund, managed by the board, for the payment of administrative expenses;
(4) Management and auditing of the pool's assets and money;
(5) Development and implementation of a program to publicize the existence of the pool, the eligibility requirements for coverage under the pool, and enrollment procedures;
(6) Creation of a grievance committee to review complaints presented by applicants to the pool and insureds;
(7) Matters as are necessary and proper to the operation of the board and the board's execution of its powers, duties, and obligations.
(C) Following a hearing on the plan of operation, the superintendent shall approve the plan if the superintendent determines that the plan will assure the fair, reasonable, and equitable administration of the pool. Reasonable notice of the hearing shall be given to all parties in interest. The plan of operation is effective on the date it is approved by the superintendent.
(D) The board shall submit amendments to the plan of operation to the superintendent as the board believes are necessary to carry out sections 3923.81 to 3923.93 of the Revised Code. The amendments do not take effect until approved by the superintendent.
Sec. 3923.85. (A) The Ohio health insurance risk pool may exercise any authority that an insurer authorized to write health insurance in this state may exercise under the Revised Code.
(B) Without limiting the pool's authority under division (A) of this section, the pool may do any of the following:
(1) Provide health benefit coverage and issue health insurance to individuals eligible for coverage under sections 3923.81 to 3923.93 of the Revised Code;
(2) Enter into contracts as necessary to carry out sections 3923.81 to 3923.93 of the Revised Code. The pool may enter into contracts with similar pools in other states, with the approval of the superintendent of insurance, for the joint performance of common administrative functions, or may contract with other entities for administrative functions.
(3) Take civil action. The pool also may be sued.
(4) Institute any legal action necessary to avoid payment of improper claims, to recover amounts paid by the pool as a mistake of fact or law, or to recover other amounts due to the pool;
(5) Establish appropriate rates, rate schedules, rate adjustments, expense allowances, agent finder fees, claim reserve formulas, and perform any actuarial function appropriate to the operation of the pool;
(6) Adopt policy forms, endorsements, riders, and application forms;
(7) Appoint appropriate legal, actuarial, and other committees as necessary to provide technical assistance in operating the pool;
(8) Employ and set the compensation of persons needed by the pool to carry out the pool's responsibilities and functions;
(9) Contract for stop-loss insurance for risks incurred by the pool;
(10) Borrow money as necessary to implement the purposes of the pool;
(11) Issue supplemental policies;
(12) Provide for and employ cost containment measures and requirements, including, but not limited to, pre-admission screening, second surgical opinion, and concurrent utilization case management, for the purpose of making the benefit plan more affordable;
(13) Design, utilize, contract, or otherwise arrange for delivery of cost-effective health care services, including establishing or contracting with preferred provider organizations and health maintenance organizations;
(14) Provide for reinsurance on a facultative or treaty basis.
(C) The board of directors of the Ohio health insurance risk pool shall establish a list of medical conditions for which an individual is eligible for coverage under a benefit plan without needing to first apply for other health insurance. The board may amend the list from time to time as appropriate.
(D) The board shall make an annual report to the governor, the speaker of the house of representatives and president of the senate, and the superintendent, not later than the first day of June each year. The report shall summarize the activities of the pool during the preceding calendar year and shall provide information on written and earned premiums, enrollment, administrative expenses, and incurred and paid losses.
Sec. 3923.86.  (A) The board of directors of the Ohio health insurance risk pool shall complete the competitive bidding process provided for in the plan of operation prior to selecting an insurer, or a third-party administrator licensed under Chapter 3959. of the Revised Code, to administer the pool.
(B) The board shall establish criteria for evaluating the persons making bids to act as administrator and shall consider all of the following:
(1) The person's ability to manage health insurance;
(2) The efficiency of the person's claims-paying process;
(3) An estimate of the total charges for the person's administration of the pool;
(4) The person's ability to administer the pool in a cost-efficient manner;
(5) The person's financial condition.
(B) The administrator shall perform delegated functions relating to the pool. These functions may include:
(1) Paying claims;
(2) Billing;
(3) Making and distributing claims forms;
(4) Assisting beneficiaries with regard to the submission of claims;
(5) Reporting to the board with regard to the operation of the pool;
(6) Determining, after the close of each calendar year, the pool's net written and earned premiums, administrative expenses, and paid and incurred losses;
(7) Reporting financial information to the board and superintendent of insurance.
Sec. 3923.87.  (A) The board of directors of the Ohio health insurance risk pool may adjust rates and rate schedules for appropriate risk factors. The board shall consider any appropriate risk factors in accordance with established actuarial and underwriting practices.
(B)(1) The board shall determine the standard risk rate by considering premium rates charged by insurers offering individual health insurance and shall set the standard risk rate using reasonable actuarial techniques. The standard risk rate shall reflect anticipated experience and expenses for such coverage.
(2) The initial pool rates shall be not less than one hundred twenty-five per cent and may not exceed one hundred fifty per cent of the rates established as standard individual rates. Subsequent rates may not exceed one hundred fifty per cent of the rates established as standard individual rates but shall provide fully for the expected cost of claims.
(C) All rates shall be submitted to the superintendent of insurance for approval prior to use. The superintendent shall consider the factors set forth in this section when evaluating the submitted rates.
Sec. 3923.88.  (A) An individual is eligible for coverage under a benefit plan if the individual is a resident and provides evidence of any of the following:
(1) The individual applied to two or more insurers for health insurance, but was refused or rejected for coverage by these insurers. A rejection for stop-loss, excess loss, or reinsurance coverage does not constitute a rejection for health insurance coverage for purposes of this division.
(2) The individual only received offers of health insurance with conditional riders.
(3) The individual only received offers of health insurance at rates exceeding the Ohio health insurance risk pool's rate.
(4) A diagnosis of the individual as having one of the medical conditions identified by the board of directors of the Ohio health insurance risk pool pursuant to division (C) of section 3923.85 of the Revised Code. An individual afflicted with one of these conditions does not need to apply for health insurance to be eligible for coverage.
(5) Eligibility for coverage under the federal "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 1955, 42 U.S.C.A. 300gg, as amended, with maintenance of health insurance for the previous eighteen months, most recently through an employer-sponsored plan, with no gap in coverage greater than sixty-three days and exhaustion of any available COBRA continuation provision or state continuation benefits. The pool may not refuse coverage to individuals meeting the eligibility requirements of this division.
(6) Eligibility for the credit for health insurance costs under section 35 of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 35, as amended.
(B) Dependents of individuals eligible for coverage under division (A) of this section also are eligible for coverage under a benefit plan. If a child is the primary insured, resident family members also are eligible for coverage.
(C) An individual is not eligible for coverage under a benefit plan, if, at the time the individual applies for coverage, the individual is covered by health insurance. An individual is not eligible for coverage under a benefit plan if the individual is or later becomes eligible for any other individual or group, private, state, federal, or military, health care benefits, including COBRA continuation provision, except as follows:
(1) Continuation or conversion coverage may be maintained for the period of time an individual is satisfying any preexisting condition waiting period for coverage under a benefit plan.
(2) If the individual is eligible for the credit for health insurance costs under section 35 of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 35, as amended, and has three months of prior creditable coverage as described in section 110(e) of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 35, as amended, the requirement of exhaustion of any available COBRA continuation provision or state continuation benefit is waived.
(3) The coverage is employer group coverage, conditioned on the limitations in divisions (A)(1) and (2) of this section.
(4) The coverage is individual coverage, conditioned on the limitations in divisions (A)(1), (2), and (3) of this section.
(D) An individual is not eligible for coverage under a benefit plan if the individual:
(1) Terminated coverage in a pool benefit plan within the twelve months preceding the date that the application is made;
(2) Is confined in a prison as defined by section 2929.01 of the Revised Code;
(3) Has premiums that are paid for or reimbursed under any government sponsored program or by any government agency or health care provider, except as an otherwise qualifying full-time employee, or dependent thereof, of a government agency or health care provider;
(4) Previously had coverage in a pool benefit plan terminated for nonpayment of premiums or fraud;
(5) Is covered by an Ohio health care basic or standard plan issued in conformity with the "Health Insurance Portability and Accountability Act of 1996," Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg, as amended, at the time of application, or was covered by a basic or standard plan within the twelve months preceding application.
(E) Eligible individuals may apply to a licensed insurance agent or to the pool's administrator for coverage under a benefit plan. The board shall pay an agent a minimum of one hundred dollars as a finder's fee for each individual application for coverage received, the amount to be set by the board.
(F) Coverage under a benefit plan shall cease at any of the following times:
(1) On the date an individual is no longer a resident of this state, except for a child under twenty-five years of age who remains financially dependent upon a parent, a child for whom another is obligated to pay child support, or a child of any age who is disabled and dependent upon the parent, unless the individual's coverage is the result of being eligible under the federal "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 1955, 42 U.S.C.A. 300gg, as amended;
(2) On the date an individual requests coverage to end;
(3) On the death of the covered individual;
(4) On the date any provision of the Revised Code requires termination of coverage;
(5) Thirty-one days after the pool sends an inquiry to the individual concerning the individual's eligibility, including an inquiry as to the individual's residence, to which the individual does not reply;
(6) Thirty-one days after a pool premium becomes due, if the premium remains unpaid;
(7) Whenever the individual ceases to meet the eligibility requirements of sections 3923.81 to 3923.94 of the Revised Code.
(G) An insured may maintain coverage under a benefit plan during the period the insured satisfies a preexisting condition waiting period for health insurance intended to replace the insured's benefit plan.
Sec. 3923.89.  (A) The Ohio health insurance risk pool shall offer coverage consistent with individual major medical coverage to each eligible individual who is not eligible for medicare, operated pursuant to Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended. The board of directors of the Ohio health insurance risk pool, with the approval of the superintendent of insurance, shall establish:
(1) Any required coverage;
(2) A minimum of two health benefit products to be offered by the pool;
(3) Applicable schedules of benefits;
(4) Exclusions to coverage and other limitations on benefits.
(B) The pool shall provide all of the following information to the beneficiaries of a benefit plan:
(1) All applicable and required definitions;
(2) A list of exclusions or limitations;
(3) A description of covered services;
(4) The deductibles, coinsurance options, and copayment options that are required or permitted under the pool.
(C) The board may adjust deductibles, amounts of stop-loss coverage, and time periods governing preexisting condition restrictions, in order to preserve the financial integrity of the pool. If the board makes such an adjustment, the board shall report the adjustment to the superintendent, in writing, within thirty days of the adjustment, along with the board's reasons for the adjustment.
(D) Benefits otherwise payable under a benefit plan shall be reduced by amounts paid or payable through any other health insurance or health care plan, through workers' compensation coverage, motor vehicle insurance, or under any federal statute or program.
(E) The pool has a cause of action against an insured for the recovery of the amount of benefits paid that are not for covered expenses. Benefits due from the pool may be reduced or refused as an offset against any amount recoverable under this section.
(F) The maximum lifetime benefit allowed by the pool is one million dollars. However, plans with lower maximum lifetime benefits may be offered.
(G) The board shall offer at least one benefit plan option that is not subject to the mandated coverage provisions of sections 1751.62, 1751.67, 3923.27 to 3923.30, 3923.54 to 3923.56, 3923.63, and 3923.64 of the Revised Code, or any other provision of the Revised Code that requires health insurance to cover specific examinations, treatments, services, or monetary benefits.
Sec. 3923.90.  (A) Except as provided in divisions (B) and (C) of this section, coverage under a benefit plan excludes charges and expenses incurred during the first twelve months following the effective date of coverage with regard to any condition for which medical advice, care, or treatment was recommended or received during the six-month period preceding the effective date of coverage. This period of preexisting condition limitation shall be reduced by the aggregate of the periods of creditable coverage that were in effect up to a maximum of sixty-three days before the application for coverage under a benefit plan.
(B) An individual eligible for enrollment in the Ohio health insurance risk pool as a result of the "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 1955, 42 U.S.C.A. 300gg-42, as amended, who has eighteen months of prior creditable coverage, the most recent of which is employer-sponsored, and who has exhausted all available COBRA continuation provision or state continuation benefits, is eligible for coverage not limited by the exclusions set forth in division (A) of this section.
(C) An individual eligible for the credit for health insurance costs under section 35 of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 35, as amended, is eligible for coverage not limited by the exclusions set forth in division (A) of this section, but only if the individual had three months of prior creditable coverage as of the date the individual seeks to enroll in the pool, not counting any period prior to a sixty-three day break in coverage.
Sec. 3923.91.  The board of directors of the Ohio health insurance risk pool shall appoint a grievance committee. An applicant for coverage or insured may file a complaint against the pool with the grievance committee. The grievance committee shall review the complaint and file a report to the board following its review. The board shall retain all written complaints and reports for a minimum of three years after receiving the complaint.
Sec. 3923.92.  At least once a year, the auditor of state shall audit and report on the affairs of the Ohio health insurance risk pool. The report shall include the results of a financial audit and an economy and efficiency audit. The auditor shall ascertain the expenses incurred in the audit and certify the amount to the board of directors of the Ohio health insurance risk pool for reimbursement. The auditor shall deposit the reimbursement received from the board into the general revenue fund.
Sec. 3923.93.  The superintendent of insurance may adopt rules, pursuant to Chapter 119. of the Revised Code, to implement sections 3923.81 to 3923.93 of the Revised Code.
Sec. 3923.83 3923.96(A)(1) This section applies to both of the following:
(a) A public employee benefit plan that issues or requires the use of a standardized identification card or an electronic technology for submission and routing of prescription drug claims pursuant to a policy, contract, or agreement for health care services;
(b) A person or entity that a public employee benefit plan contracts with to issue a standardized identification card or an electronic technology described in division (A)(1)(a) of this section.
(2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or required use of a standardized identification card or an electronic technology for the submission and routing of prescription drug claims in connection with either of the following:
(a) Any individual or group policy of insurance covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, medicare, tricare, specified disease, or vision care; coverage under a one-time-limited-duration policy of not longer than six months; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar law; automobile medical payment insurance; or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
(b) Coverage provided under medicaid, as defined in section 5111.01 of the Revised Code.
(B) A standardized identification card or an electronic technology issued or required to be used as provided in division (A)(1) of this section shall contain uniform prescription drug information in accordance with either division (B)(1) or (2) of this section.
(1) The standardized identification card or the electronic technology shall be in a format and contain information fields approved by the national council for prescription drug programs or a successor organization, as specified in the council's or successor organization's pharmacy identification card implementation guide in effect on the first day of October most immediately preceding the issuance or required use of the standardized identification card or the electronic technology.
(2) If the public employee benefit plan or person under contract with the plan to issue a standardized identification card or an electronic technology requires the information for the submission and routing of a claim, the standardized identification card or the electronic technology shall contain any of the following information:
(a) The plan's name;
(b) The insured's name, group number, and identification number;
(c) A telephone number to inquire about pharmacy-related issues;
(d) The issuer's international identification number, labeled as "ANSI BIN" or "RxBIN";
(e) The processor's control number, labeled as "RxPCN";
(f) The insured's pharmacy benefits group number if different from the insured's medical group number, labeled as "RxGrp."
(C) If the standardized identification card or the electronic technology issued or required to be used as provided in division (A)(1) of this section is also used for submission and routing of nonpharmacy claims, the designation "Rx" is required to be included as part of the labels identified in divisions (B)(2)(d) and (e) of this section if the issuer's international identification number or the processor's control number is different for medical and pharmacy claims.
(D)(1) Except as provided in division (D)(2) of this section, if there is a change in the information contained in the standardized identification card or the electronic technology issued to an insured, the public employee benefit plan or person under contract with the plan to issue a standardized identification card or electronic technology shall issue a new card or electronic technology to the insured.
(2) A public employee benefit plan or person under contract with the plan is not required under division (D)(1) of this section to issue a new card or electronic technology to an insured more than once during a twelve-month period.
(F)(E) Nothing in this section shall be construed as requiring a public employee benefit plan to produce more than one standardized identification card or one electronic technology for use by insureds accessing health care benefits provided under a health benefit plan.
Sec. 3924.08.  (A) The board of directors of the Ohio health reinsurance program shall consist of nine appointed members who shall serve staggered terms as determined by the initial board for its members and by the plan of operation of the program for members of subsequent boards. Within thirty days after April 14, 1993, the members of the board shall be appointed, as follows:
(1) The chairperson of the senate committee having jurisdiction over insurance shall appoint the following members:
(a) Two member carriers that are small employer carriers;
(b) One member carrier that is a health insuring corporation predominantly in the small employer market;
(c) One representative of providers of health care.
(2) The chairperson of the committee in the house of representatives having jurisdiction over insurance shall appoint the following members:
(a) One member carrier that is a small employer carrier;
(b) One member carrier whose principal health insurance business is in the large employer market;
(c) One representative of an employer with fifty or fewer employees;
(d) One representative of consumers in this state.
(3) The superintendent of insurance shall appoint a representative of a member carrier operating in the small employer market who is a fellow of the society of actuaries.
The superintendent, a member of the house of representatives appointed by the speaker of the house of representatives, and a member of the senate appointed by the president of the senate, shall be ex-officio members of the board. The membership of all boards subsequent to the initial board shall reflect the distribution described in division (A) of this section.
The chairperson of the initial board and each subsequent board shall represent a small employer member carrier and shall be elected by a majority of the voting members of the board. Each chairperson shall serve for the maximum duration established in the plan of operation.
(B) Within one hundred eighty days after the appointment of the initial board, the board shall establish a plan of operation and, thereafter, any amendments to the plan that are necessary or suitable, to assure the fair, reasonable, and equitable administration of the program. The board shall, immediately upon adoption, provide to the superintendent copies of the plan of operation and all subsequent amendments to it.
(C) The plan of operation shall establish rules, conditions, and procedures for all of the following:
(1) The handling and accounting of assets and moneys of the program and for an annual fiscal reporting to the superintendent;
(2) Filling vacancies on the board;
(3) Selecting an administrator of the program, and setting forth the powers and duties of the administrator. The administrator may be a carrier as defined in section 3924.01 of the Revised Code or a person licensed as an administrator under Chapter 3959. of the Revised Code, or the board may, in its sole discretion, choose to serve as administrator of the program.
(4) Reinsuring risks in accordance with sections 3924.07 to 3924.14 of the Revised Code;
(5) Collecting assessments subject to section 3924.13 of the Revised Code from all members to provide for claims reinsured by the program and for administrative expenses incurred or estimated to be incurred during the period for which the assessment is made;
(6) Providing protection for carriers from the financial risk associated with small employers that present poor credit risks;
(7) Establishing standards for the coverage of small employers that have a high turnover of employees;
(8) Establishing an appeals process for carriers to seek relief when a carrier has experienced an unfair share of administrative and credit risks;
(9) Establishing the adjusted average market premium prices for use by the OHC plans for individuals, for groups of two to twenty-five employees, and for groups of twenty-six to fifty employees that are offered in the state;
(10) Establishing participation standards at issue and renewal for reinsured cases;
(11) Reinsuring risks and collecting assessments in accordance with division (G) of section 3924.11 of the Revised Code;
(12) Any additional matters as determined by the board.
Sec. 3924.09.  The Ohio health reinsurance program shall have the general powers and authority granted under the laws of the state to insurance companies licensed to transact sickness and accident insurance, except the power to issue insurance. The board of directors of the program also shall have the specific authority to do all of the following:
(A) Enter into contracts as are necessary or proper to carry out the provisions and purposes of sections 3924.07 to 3924.14 of the Revised Code, including the authority to enter into contracts with similar programs of other states for the joint performance of common functions, or with persons or other organizations for the performance of administrative functions;
(B) Sue or be sued, including taking any legal actions necessary or proper for recovery of any assessments for, on behalf of, or against any program or board member;
(C) Take such legal action as is necessary to avoid the payment of improper claims against the program;
(D) Design the OHC plans which, when offered by a carrier, are eligible for reinsurance and issue reinsurance policies in accordance with the requirements of sections 3924.07 to 3924.14 of the Revised Code;
(E) Establish rules, conditions, and procedures pertaining to the reinsurance of members' risks by the program;
(F) Establish appropriate rates, rate schedules, rate adjustments, rate classifications, and any other actuarial functions appropriate to the operation of the program;
(G) Assess members in accordance with division (G) of section 3924.11 and the provisions of section 3924.13 of the Revised Code, and make such advance interim assessments as may be reasonable and necessary for organizational and interim operating expenses. Any interim assessments shall be credited as offsets against any regular assessments due following the close of the calendar year.
(H) Appoint members to appropriate legal, actuarial, and other committees if necessary to provide technical assistance with respect to the operation of the program, policy and other contract design, and any other function within the authority of the program;
(I) Borrow money to effect the purposes of the program. Any notes or other evidence of indebtedness of the program not in default shall be legal investments for carriers and may be carried as admitted assets.
(J) Reinsure risks, collect assessments, and otherwise carry out its duties under division (G) of section 3924.11 of the Revised Code;
(K) Study the operation of the Ohio health reinsurance program and the open enrollment reinsurance program and, based on its findings, make legislative recommendations to the general assembly for improvements in the effectiveness, operation, and integrity of the programs;
(L) Design a basic and standard plan for purposes of sections 1751.16, and 3923.122, and 3923.581 of the Revised Code.
Sec. 3924.11.  Any member of the Ohio health reinsurance program may reinsure small employer groups or individuals in accordance with the following conditions and limitations:
(A) A small employer group or individual may be reinsured within sixty days after the commencement of the group's or individual's coverage under the plan.
(B)(1) The carrier may reinsure either the entire eligible group or any eligible individual, in accordance with the premium rates established in section 3924.12 of the Revised Code, upon commencement of the coverage.
(2) The carrier may reinsure an eligible employee, or the dependents of an eligible employee, who were previously excluded from group coverage for medical reasons, and shall reinsure such employees or dependents within sixty days after the carrier is required to include them in the group coverage.
(C) With respect to an OHC plan, the program shall reinsure the level of coverage provided.
(D) With respect to other plans issued to small employers, the program shall reinsure the level of coverage provided up to, but not exceeding, the level of coverage provided in an OHC carrier reimbursement plan. In the coverage provided to small employers, carriers shall be required to use high-cost care management, hospital precertification techniques, and other cost containment mechanisms established by the program.
(E) A carrier may not reinsure existing business, except pursuant to division (A) of this section.
(F) If an employer group is covered under a plan other than an OHC carrier reimbursement plan and the carrier chooses to reinsure the group subsequent to the initial coverage period, or if a new individual joins the group and the carrier wants to reinsure that individual, the carrier shall not force the employer to change to an OHC carrier reimbursement plan. The carrier shall allow the employer to maintain the same benefit plan and reinsure only that portion of the plan that is consistent with an OHC carrier reimbursement plan.
(G) With respect to coverage provided to an individual acquired under section 3923.58 or a federally eligible individual acquired under section 3923.581 of the Revised Code, the following conditions and limitations apply:
(1) Within sixty days after the commencement of the initial coverage, any carrier may reinsure coverage of such an individual with the open enrollment reinsurance program in accordance with division (G) of this section. Premium rates charged for coverage reinsured by the program shall be established in accordance with section 3924.12 of the Revised Code.
(2) The board of directors of the Ohio health reinsurance program shall establish the open enrollment reinsurance fund for coverage provided under section 3923.58 of the Revised Code and, with respect to federally eligible individuals, coverage provided under section 3923.581 of the Revised Code. The fund shall be maintained separately from any reinsurance fund established for Ohio health care plans issued pursuant to sections 3924.07 to 3924.14 of the Revised Code. The board shall calculate, on a retrospective basis, the amount needed for maintenance of the open enrollment reinsurance fund and, on the basis of that calculation, shall determine the amount to be assessed each carrier that is required to provide open enrollment coverage.
Assessments shall be apportioned by the board among all carriers participating in the open enrollment reinsurance program in proportion to their respective shares of the total premiums, net of reinsurance premiums paid by a carrier for open enrollment coverage and net of reinsurance premiums paid by the carrier for all other individual health benefit plans, earned in this state from all health benefit plans covering individuals that are issued by all such carriers during the calendar year coinciding with or ending during the fiscal year of the open enrollment program, or on any other equitable basis reflecting coverage of individuals in this state as may be provided in the plan of operation adopted by the board. In no event shall the assessment of any carrier under this section exceed, on an annual basis, three per cent of its Ohio premiums for health benefit plans covering individuals as reported on its most recent annual statement filed with the superintendent of insurance.
The board shall submit its determination of the amount of the assessment to the superintendent for review of the accuracy of the calculation of the assessment. Upon approval by the superintendent, each carrier shall, within thirty days after receipt of the notice of assessment, submit the assessment to the board for purposes of the open enrollment reinsurance fund.
(3) If the assessments made and collected pursuant to division (G)(2) of this section are not sufficient to pay the claims reinsured under division (G) of this section and the allocated administrative expenses, incurred or estimated to be incurred during the period for which the assessment was made, the secretary of the board shall immediately notify the superintendent, and the superintendent shall suspend the operation of open enrollment under section 3923.58 of the Revised Code and, with respect to federally eligible individuals, under section 3923.581 of the Revised Code until the board has collected in subsequent years through assessments made pursuant to division (G)(2) of this section an amount sufficient to pay such claims and administrative expenses.
(4)(a) Any carrier that is subject to open enrollment under section 3923.58 of the Revised Code may elect not to participate in the open enrollment reinsurance program under division (G) of this section by filing an application with the superintendent and obtaining the superintendent's approval. In determining whether to approve an application, the superintendent shall consider whether the carrier meets all of the following standards:
(i) Demonstration by the carrier of a substantial and established market presence;
(ii) Demonstrated experience in the individual market and history of rating and underwriting individual plans;
(iii) Commitment to comply with the requirements of section 3923.58 of the Revised Code;
(iv) Financial ability to assume and manage the risk of enrolling open enrollment individuals without the need for, or protection of, reinsurance.
(b) A carrier whose application for nonparticipation has been rejected by the superintendent may appeal the decision in accordance with Chapter 119. of the Revised Code. A carrier that has received approval of the superintendent not to participate in the open enrollment reinsurance program shall, on or before the first day of December, annually certify to the superintendent that it continues to meet the standards described in division (G)(4)(a) of this section.
(c) In any year subsequent to the year in which its application not to participate has been approved, a carrier may elect to participate in the open enrollment reinsurance program by giving notice to the superintendent and board on or before the thirty-first day of December. If, after a period of nonparticipation, a carrier elects to participate in the open enrollment reinsurance program, the carrier retains the risks it assumed during the period when it was not participating.
(d) The superintendent may, at any time, authorize a carrier to modify an election not to participate if the risk from the carrier's open enrollment business jeopardizes the financial condition of the carrier. If the superintendent authorizes the carrier to again participate in the open enrollment reinsurance program, the carrier shall retain the risks it assumed during the period of nonparticipation.
(5)(a) The open enrollment reinsurance program shall be operated separately from the Ohio health reinsurance program.
(b) A carrier's election to participate in the open enrollment reinsurance program under division (G) of this section shall not be construed as an election to participate in the Ohio health reinsurance program under section 3924.07 of the Revised Code.
Sec. 3924.73.  (A) As used in this section:
(1) "Health care insurer" means any person legally engaged in the business of providing sickness and accident insurance contracts in this state, a health insuring corporation organized under Chapter 1751. of the Revised Code, or any legal entity that is self-insured and provides health care benefits to its employees or members.
(2) "Small employer" has the same meaning as in section 3924.01 of the Revised Code.
(B)(1) Subject to division (B)(2) of this section, nothing in sections 3924.61 to 3924.74 of the Revised Code shall be construed to limit the rights, privileges, or protections of employees or small employers under sections 3924.01 to 3924.14 of the Revised Code.
(2) If any account holder enrolls or applies to enroll in a policy or contract offered by a health care insurer providing sickness and accident coverage that is more comprehensive than, and has a deductible amount that is less than, the coverage and deductible amount of the policy under which the account holder currently is enrolled, the health care insurer to which the account holder applies may subject the account holder to the same medical review, waiting periods, and underwriting requirements to which the health care insurer generally subjects other enrollees or applicants, unless the account holder enrolls or applies to enroll during a designated period of open enrollment.
Section 2. That existing sections 1731.05, 1739.05, 1751.17, 1751.18, 3923.57, 3923.83, 3924.08, 3924.09, 3924.11, and 3924.73 and sections 1751.15, 3923.58, 3923.581, and 3923.59 of the Revised Code are hereby repealed.
Section 3.  Sections 1 and 2 of this act, except for sections 1731.05, 1739.05, 1751.17, 1751.18, 3923.57, 3924.08, 3924.09, 3924.11, and 3924.73 of the Revised Code, take effect at the earliest time permitted by law. The amendment by this act of sections 1731.05, 1739.05, 1751.17, 1751.18, 3923.57, 3924.08, 3924.09, 3924.11, and 3924.73 of the Revised Code take effect June 1, 2005.
Section 4.  The repeal by this act of sections 1751.15, 3923.58, 3923.581, and 3923.59 of the Revised Code takes effect June 1, 2005.
Section 5. Sections 3923.81 to 3923.93 of the Revised Code as enacted by this act apply to health care policies, contracts, and agreements delivered, issued for delivery, or renewed on or after January 1, 2007. Assessments shall apply to all applicable insurance policies in force, beginning January 1, 2007. Coverage under the Ohio Health Insurance Risk Pool must be made available no later than June 1, 2007, for individuals eligible for coverage under the "Trade Adjustment Assistance Act of 2002," and no later than June 1, 2008, for all other applicants. The act's repeal of the open enrollment provisions of the Revised Code does not affect existing obligations to individuals pursuant to open enrollment coverage obtained under sections 1751.15, 3923.58, 3923.581, and 3923.59 of the Revised Code prior to the repeal.
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