Sec. 1739.02. (A) A trade association, industry
association, | 14 |
or professional association that has been organized
and maintained | 15 |
in good faith for a continuous period of one year
or more for | 16 |
purposes other than obtaining insurance may
establish, maintain, | 17 |
or operate a group self-insurance program
under a multiple | 18 |
employer welfare arrangement that is chartered
and created in this | 19 |
state under sections 1739.01 to 1739.22 of
the Revised Code. | 20 |
Sec. 1739.27. No insurance agent, broker, or other person | 35 |
shall advertise, solicit, negotiate, collect a premium on, or sell | 36 |
any enrollment in, a group self-insurance program in this state, | 37 |
unless the multiple employer welfare arrangement has a valid | 38 |
certificate of authority from the superintendent of insurance. | 39 |
Sec. 1751.02. (A) Notwithstanding any law in this state to | 50 |
the
contrary, any
corporation, as defined in section 1751.01 of | 51 |
the
Revised Code, may apply to the
superintendent of insurance for | 52 |
a certificate of authority to
establish and operate a health | 53 |
insuring corporation. If the corporation
applying for a | 54 |
certificate of authority is a
foreign corporation domiciled in a | 55 |
state without laws
similar to those of this chapter,
the | 56 |
corporation must form a domestic corporation to apply for, obtain, | 57 |
and
maintain a certificate of authority under this chapter. | 58 |
(C) Except as provided by division (D) of this section,
no | 62 |
political subdivision or department, office, or
institution of | 63 |
this state, or corporation formed by or on behalf of any
political | 64 |
subdivision or department, office, or institution of this state, | 65 |
shall establish, operate, or perform the services of a health | 66 |
insuring
corporation.
Nothing in this
section shall be construed | 67 |
to preclude a board of county
commissioners, a county board of | 68 |
mental retardation and
developmental disabilities, an alcohol and | 69 |
drug addiction
services board, a board of alcohol, drug addiction, | 70 |
and mental
health services, or a community mental health board, or | 71 |
a public
entity formed by or on behalf of any of these boards, | 72 |
from using
managed care techniques in carrying out the board's or | 73 |
public
entity's duties pursuant to the requirements of
Chapters | 74 |
307., 329., 340., and
5126. of the Revised
Code. However, no such | 75 |
board
or public entity may operate so as to compete in the private | 76 |
sector with health insuring corporations holding certificates of | 77 |
authority under this chapter. | 78 |
(E) A health insuring
corporation shall operate in this state | 84 |
in compliance with this
chapter and Chapter 1753. of the Revised | 85 |
Code, and with sections
3702.51 to 3702.62 of the
Revised
Code, | 86 |
and shall operate in
conformity with its filings with the | 87 |
superintendent under this
chapter, including filings made pursuant | 88 |
to sections 1751.03,
1751.11, 1751.12, and 1751.31 of the
Revised | 89 |
Code. | 90 |
(F) An insurer licensed under Title XXXIX of
the
Revised Code | 91 |
need not obtain a certificate of
authority as a health insuring | 92 |
corporation to offer an open
panel plan as long as the providers | 93 |
and health care facilities
participating in the open panel plan | 94 |
receive their compensation
directly from the insurer. If the | 95 |
providers and health care
facilities participating in the open | 96 |
panel plan receive their
compensation from any person other than | 97 |
the insurer, or if the
insurer offers a closed panel plan, the | 98 |
insurer must obtain a
certificate of authority as a health | 99 |
insuring corporation. | 100 |
(G) An intermediary
organization need not obtain a | 101 |
certificate of authority as a
health insuring corporation, | 102 |
regardless of the method of reimbursement to the
intermediary | 103 |
organization,
as long as a health insuring
corporation or a | 104 |
self-insured employer maintains the ultimate responsibility
to | 105 |
assure delivery of all health care services required by the | 106 |
contract
between the health insuring corporation and the | 107 |
subscriber and
the laws of this state or between the self-insured | 108 |
employer and its
employees. | 109 |
Nothing in this section shall be construed to require any | 110 |
health care facility, provider, health delivery network, or | 111 |
intermediary organization that contracts with a health insuring | 112 |
corporation or self-insured employer, regardless of the method
of | 113 |
reimbursement to the health care facility, provider, health | 114 |
delivery network, or intermediary organization, to obtain a | 115 |
certificate of authority as a health insuring corporation under | 116 |
this chapter, unless otherwise provided, in the case of
contracts | 117 |
with a self-insured employer, by operation of the
"Employee | 118 |
Retirement
Income
Security
Act of 1974," 88
Stat. 829, 29
U.S.C.A. | 119 |
1001, as amended. | 120 |
(H) Any health delivery
network doing business in this state, | 121 |
including any
health delivery network that is functioning as an | 122 |
intermediary organization
doing business in this
state, that is | 123 |
not required to
obtain a certificate of authority under this | 124 |
chapter shall
certify to the superintendent annually, not later | 125 |
than the
first day of July, and shall
provide a statement signed | 126 |
by the highest ranking official which
includes the following | 127 |
information: | 128 |
(I) The superintendent
shall not issue a certificate of | 134 |
authority to a health insuring
corporation that is a provider | 135 |
sponsored organization unless all
health care plans to be offered | 136 |
by the health insuring
corporation provide basic health care | 137 |
services.
Substantially all of the physicians and hospitals with | 138 |
ownership or control of the provider sponsored organization, as | 139 |
defined in division (X) of
section 1751.01 of the Revised
Code, | 140 |
shall also be
participating providers for the provision of basic | 141 |
health care
services for health care plans offered by the provider | 142 |
sponsored
organization. If a health insuring corporation that is a | 143 |
provider sponsored organization offers health care plans that do | 144 |
not provide basic health care services, the health insuring | 145 |
corporation shall be deemed, for purposes of section 1751.35 of | 146 |
the Revised Code, to have failed to substantially
comply with this | 147 |
chapter. | 148 |
(k) Interest or rents
accrued on conditional sales | 200 |
agreements, security interests,
chattel mortgages, and real or | 201 |
personal property under lease to
other corporations, that conform | 202 |
to section 3925.08 of the
Revised
Code, not exceeding on any | 203 |
individual investment the amount of one year's total due and | 204 |
accrued interest or rent; | 205 |
(r) The cost of
furniture, equipment, and medical equipment, | 225 |
less accumulated
depreciation on the furniture and equipment to be | 226 |
applied pro rata over a
period not to exceed five years, and of | 227 |
medical and
pharmaceutical supplies, that are under the control of | 228 |
the
health insuring corporation, provided these assets do not | 229 |
exceed
fifteen per cent of admitted assets; | 230 |
(C)(1) Every health
insuring corporation authorized to | 241 |
provide basic health care
services, which health insuring | 242 |
corporation is not a provider sponsored
organization, shall | 243 |
maintain total admitted assets equal to at least
one hundred ten | 244 |
per cent of the liabilities of the corporation.
However, at no | 245 |
time shall the corporation's net worth be less
than one million | 246 |
two hundred thousand dollars. | 247 |
(4) Every health insuring corporation authorized to
provide | 260 |
both basic health care services and supplemental health
care | 261 |
services, which health insuring corporation is not a provider | 262 |
sponsored
organization, shall maintain total admitted assets equal | 263 |
to at
least one hundred ten per cent of the liabilities of the | 264 |
corporation. However, at no time shall the corporation's net
worth | 265 |
be less than one million seven hundred thousand
dollars. | 266 |
(5) Every health insuring corporation authorized to provide | 267 |
both basic health care services and specialty health care | 268 |
services, which health insuring corporation is not a provider | 269 |
sponsored
organization, shall maintain total admitted assets equal | 270 |
to at least
one hundred ten per cent of the liabilities of the | 271 |
corporation.
However, at no time shall the corporation's net worth | 272 |
be less
than one million four hundred fifty thousand dollars. | 273 |
(7) Every health insuring corporation authorized to provide | 280 |
both basic health care services and supplemental health care | 281 |
services, which health insuring corporation is a provider | 282 |
sponsored organization, shall maintain total admitted assets
equal | 283 |
to at least one hundred ten per cent of the liabilities of
the | 284 |
corporation. However, at no time shall the corporation's
net worth | 285 |
be less than one million five hundred thousand
dollars. | 286 |
(8) Every health insuring corporation authorized to provide | 287 |
both basic health care services and specialty health care | 288 |
services, which health insuring corporation is a provider | 289 |
sponsored organization, shall maintain total admitted assets
equal | 290 |
to at least one hundred ten per cent of the liabilities of
the | 291 |
corporation. However, at no time shall the corporation's
net worth | 292 |
be less than one million two hundred fifty thousand
dollars. | 293 |
Sec. 3901.78. Upon the filing of each of its annual | 314 |
statements, or as soon
thereafter as practicable, the | 315 |
superintendent of insurance shall issue to each
insurance company | 316 |
or association authorized to do business in this state but not | 317 |
incorporated under the laws of this state a
certificate that it | 318 |
has complied with the laws of this state.
Such
certificate of | 319 |
compliance shall also contain a statement of
the
amounts of the | 320 |
paid-up capital stock, assets, liabilities,
income,
and | 321 |
expenditures of the
company or association for the
preceding
year, | 322 |
as shown by its annual
statement for that year.
The
superintendent | 323 |
shall issue to each
newly-applying
company or
association
that the | 324 |
superintendent finds should be
authorized to
do business in this | 325 |
state, a certificate that it has
complied with
the laws of
this | 326 |
state, which certificate shall
contain a
statement of the amounts | 327 |
of its
paid-up capital stock,
assets,
liabilities, income, and | 328 |
expenditures as shown
by a
financial
statement submitted by it, | 329 |
under the oath of its
officers.of compliance, an original of | 330 |
which must be published in accordance with section 3901.781 of the | 331 |
Revised Code in every county where the insurance company or | 332 |
association has an agency. Upon request or in any other | 333 |
circumstance that the superintendent determines to be appropriate, | 334 |
the superintendent may issue other certificates of compliance, | 335 |
which certificates are not subject to section 3901.781 of the | 336 |
Revised Code, to insurance companies and associations authorized | 337 |
to do business in this state. Certificates of compliance either | 338 |
must be on forms established by the national association of | 339 |
insurance commissioners or on such other forms as the | 340 |
superintendent may prescribe. | 341 |
Sec. 3999.18. (A) No person shall establish, operate, or | 342 |
maintain any entity that delivers, issues for delivery, or renews | 343 |
any policy of sickness and accident insurance or contract for | 344 |
health care services in this state if the entity is required to, | 345 |
but does not, have a valid certificate of authority under Chapter | 346 |
1751. or Title XXXIX of the Revised Code. | 347 |
(B) No insurance agent, broker, or other person shall | 348 |
advertise, solicit, negotiate, collect a premium on, or sell any | 349 |
policy of sickness and accident insurance or contract for health | 350 |
care services in this state unless the entity that delivers, | 351 |
issues for delivery, or renews the policy or contract is subject | 352 |
to and has complied with division (A) of this section. | 353 |