As Reported by the Senate Insurance, Commerce and Labor Committee

126th General Assembly Regular Session 2005-2006

Sub. S. B. No. 5

Senator Hottinger 

---

A BILL

To amend sections 1731.01, 1731.03, 1731.04, 1731.09,

1

2921.01, 3924.04, and 3924.06 and to enact

2

sections 3923.81 and 3961.01 to 3961.09 of the

3

Revised Code to regulate discount medical plan

4

organizations concerning provider agreements and

5

marketing, disclosure, cancellation, and refund

6

requirements; to make changes to the Small

7

Employer Health Care Alliances Law and the Small

8

Employer Health Benefit Plans Law; to exclude

9

insurance consultants from the definition of

10

public servant for purposes of the Offenses

11

Against Justice and Public Administration Law; and

12

to limit the amount of copayments and deductibles

13

paid by persons insured by health benefit plans.

14

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1.  That sections 1731.01, 1731.03, 1731.04, 1731.09,	15
2921.01, 3924.04, and 3924.06 be amended and sections 3923.81,	16
3961.01, 3961.02, 3961.03, 3961.04, 3961.05, 3961.06, 3961.07,	17
3961.08, and 3961.09 of the Revised Code be enacted to read as	18
follows:	19

Sec. 1731.01.  As used in this chapter:

20

(A) "Alliance" or "small employer health care alliance" means	21
an existing or newly created organization that has been granted a	22
certificate of authority by the superintendent of insurance under	23
section 1731.021 of the Revised Code and that is either of the	24
following:	25

(1) A chamber of commerce, trade association, professional	26
organization, or any other organization that has all of the	27
following characteristics:	28

(a) Is a nonprofit corporation or association;

29

(b) Has members that include or are exclusively small	30
employers;	31

(c) Sponsors or is part of a program to assist such small	32
employer members to obtain coverage for their employees under one	33
or more health benefit plans;	34

(d) Except as provided in division (A)(1)(e) of this section,	35
is not directly or indirectly controlled, through voting	36
membership, representation on its governing board, or otherwise,	37
by any insurance company, person, firm, or corporation that sells	38
insurance, any provider, or by persons who are officers, trustees,	39
or directors of such enterprises, or by any combination of such	40
enterprises or persons.	41

(e) Division (A)(1)(d) of this section does not apply to an	42
organization that is comprised of members who are either insurance	43
agents or providers, that is controlled by the organization's	44
members or by the organization itself, and that elects to offer	45
health insurance exclusively to any or all of the following:	46

(i) Employees and retirees of the organization;

47

(ii) Insurance agents and providers that are members of the	48
organization;	49

(iii) Employees and retirees of the agents or providers	50
specified in division (A)(1)(e)(ii) of this section;	51

(iv) Families and dependents of the employees, providers,	52
agents, and retirees specified in divisions (A)(1)(e)(i),	53
(A)(1)(e)(ii), and (A)(1)(e)(iii) of this section.	54

(2) A nonprofit corporation controlled by one or more	55
organizations described in division (A)(1) of this section.	56

(B) "Alliance program" or "alliance health care program"	57
means a program sponsored by a small employer health care alliance	58
that assists small employer members of such small employer health	59
care alliance or any other small employer health care alliance to	60
obtain coverage for their employees under one or more health	61
benefit plans, and that includes at least one agreement between a	62
small employer health care alliance and an insurer that contains	63
the insurer's agreement to offer and sell one or more health	64
benefit plans to such small employers and contains all of the	65
other features required under section 1731.04 of the Revised Code.	66

(C) "Eligible employees, retirees, their dependents, and	67
members of their families," as used together or separately, means	68
the active employees of a small employer, or retired former	69
employees of a small employer or predecessor firm or organization,	70
their dependents or members of their families, who are eligible	71
for coverage under the terms of the applicable alliance program.	72

(D) "Enrolled small employer" or "enrolled employer" means a	73
small employer that has obtained coverage for its eligible	74
employees from an insurer under an alliance program.	75

(E) "Health benefit plan" means any hospital or medical	76
expense policy of insurance or a health care plan provided by an	77
insurer, including a health insuring corporation plan, provided by	78
or through an insurer, or any combination thereof. "Health benefit	79
plan" does not include any of the following:	80

(1) A policy covering only accident, credit, dental,	81
disability income, long-term care, hospital indemnity, medicare	82
supplement, specified disease, or vision care, except where any of	83
the foregoing is offered as an addition, indorsement, or rider to	84
a health benefit plan;	85

(2) Coverage issued as a supplement to liability insurance,	86
insurance arising out of a workers' compensation or similar law,	87
automobile medical-payment insurance, or insurance under which	88
benefits are payable with or without regard to fault and which is	89
statutorily required to be contained in any liability insurance	90
policy or equivalent self-insurance;	91

(3) Coverage issued by a health insuring corporation	92
authorized to offer supplemental health care services only.	93

(F) "Insurer" means an insurance company authorized to do the	94
business of sickness and accident insurance in this state or, for	95
the purposes of this chapter, a health insuring corporation	96
authorized to issue health care plans in this state.	97

(G) "Participants" or "beneficiaries" means those eligible	98
employees, retirees, their dependents, and members of their	99
families who are covered by health benefit plans provided by an	100
insurer to enrolled small employers under an alliance program.	101

(H) "Provider" means a hospital, urgent care facility,	102
nursing home, physician, podiatrist, dentist, pharmacist,	103
chiropractor, certified registered nurse anesthetist, dietitian,	104
or other health care provider licensed by this state, or group of	105
such health care providers.	106

(I) "Qualified alliance program" means an alliance program	107
under which health care benefits are provided to twoone thousand	108
five hundred or more participants.	109

(J) "Small employer," regardless of its definition in any	110
other chapter of the Revised Code, in this chapter means an	111
employer that employs no more than onefive hundred fifty	112
full-time employees, at least a majority of whom are employed at	113
locations within this state.	114

(1) For this purpose:

115

(a) Each entity that is controlled by, controls, or is under	116
common control with, one or more other entities shall, together	117
with such other entities, be considered to be a single employer.	118

(b) "Full-time employee" means a person who normally works at	119
least twenty-five hours per week and at least forty weeks per year	120
for the employer.	121

(c) An employer will be treated as having onefive hundred	122
fifty or fewer full-time employees on any day if, during the prior	123
calendar year or any twelve consecutive months during the	124
twenty-four full months immediately preceding that day, the mean	125
number of full-time employees employed by the employer does not	126
exceed onefive hundred fifty.	127

(2) An employer that qualifies as a small employer for	128
purposes of becoming an enrolled small employer continues to be	129
treated as a small employer for purposes of this chapter until	130
such time as it fails to meet the conditions described in division	131
(J)(1) of this section for any period of thirty-six consecutive	132
months after first becoming an enrolled small employer, unless	133
earlier disqualified under the terms of the alliance program.	134

Sec. 1731.03.  (A) A small employer health care alliance may	135
do any of the following:	136

(1) Negotiate and enter into agreements with one or more	137
insurers for the insurers to offer and provide one or more health	138
benefit plans to small employers for their employees and retirees,	139
and the dependents and members of the families of such employees	140
and retirees, which coverage may be made available to enrolled	141
small employers without regard to industrial, rating, or other	142
classifications among the enrolled small employers under an	143
alliance program, except as otherwise provided under the alliance	144
program, and for the alliance to perform, or contract with others	145
for the performance of, functions under or with respect to the	146
alliance program;	147

(2) Contract with another alliance for the inclusion of the	148
small employer members of one in the alliance program of the	149
other;	150

(3) Provide or cause to be provided to small employers	151
information concerning the availability, coverage, benefits,	152
premiums, and other information regarding an alliance program and	153
promote the alliance program;	154

(4) Provide, or contract with others to provide, enrollment,	155
record keeping, information, premium billing, collection and	156
transmittal, and other services under an alliance program;	157

(5) Receive reports and information from the insurer and	158
negotiate and enter into agreements with respect to inspection and	159
audit of the books and records of the insurer;	160

(6) Provide services to and on behalf of an alliance program	161
sponsored by another alliance, including entering into an	162
agreement described in division (B) of section 1731.01 of the	163
Revised Code on behalf of the other alliance;	164

(7) If it is a nonprofit corporation created under Chapter	165
1702. of the Revised Code, exercise all powers and authority of	166
such corporations under the laws of the state, or, if otherwise	167
constituted, exercise such powers and authority as apply to it	168
under the applicable laws, and its articles, regulations,	169
constitution, bylaws, or other relevant governing instruments.	170

(B) A small employer health care alliance is not and shall	171
not be regarded for any purpose of law as an insurer, an offeror	172
or seller of any insurance, a partner of or joint venturer with	173
any insurer, an agent of, or solicitor for an agent of, or	174
representative of, an insurer or an offeror or seller of any	175
insurance, an adjuster of claims, or a third-party administrator,	176
and will not be liable under or by reason of any insurance	177
coverage or other health benefit plan provided or not provided by	178
any insurer or by reason of any conditions or restrictions on	179
eligibility or benefits under an alliance program or any insurance	180
or other health benefit plan provided under an alliance program or	181
by reason of the application of those conditions or restrictions.	182

(C) The promotion of an alliance program by an alliance or by	183
an insurer is not and shall not be regarded for any purpose of law	184
as the offer, solicitation, or sale of insurance.	185

(D)(1) No alliance shall adopt, impose, or enforce medical	186
underwriting rules or underwriting rules requiring a small	187
employer to have more than a minimum number of employees for the	188
purpose of determining whether an alliance member is eligible to	189
purchase a policy, contract, or plan of health insurance or health	190
benefits from any insurer in connection with the alliance health	191
care program.	192

(2) No alliance shall reject any applicant for membership in	193
the alliance based on the health status of the applicant's	194
employees or their dependents or because the small employer does	195
not have more than a minimum number of employees.	196

(3) A violation of division (D)(1) or (2) of this section is	197
deemed to be an unfair and deceptive act or practice in the	198
business of insurance under sections 3901.19 to 3901.26 of the	199
Revised Code.	200

(4) Nothing in division (D)(1) or (2) of this section shall	201
be construed as inhibiting or preventing an alliance from	202
adopting, imposing, and enforcing rules, conditions, limitations,	203
or restrictions that are based on factors other than the health	204
status of employees or their dependents or the size of the small	205
employer for the purpose of determining whether a small employer	206
is eligible to become a member of the alliance. Division (D)(1) of	207
this section does not apply to an insurer that sells health	208
coverage to an alliance member under an alliance health care	209
program.	210

(E) HealthExcept as otherwise specified in section 1731.09	211
of the Revised Code, health benefit plans offered and sold to	212
alliance members that are small employers as defined in section	213
3924.01 of the Revised Code are subject to sections 3924.01 to	214
3924.14 of the Revised Code.	215

(F) Any person who represents an alliance in bargaining or	216
negotiating a health benefit plan with an insurer shall disclose	217
to the governing board of the alliance any direct or indirect	218
financial relationship the person has or had during the past two	219
years with the insurer.	220

Sec. 1731.04.  (A) An agreement between an alliance and an	221
insurer referred to in division (B) of section 1731.01 of the	222
Revised Code shall contain at least the following:	223

(1) A provision requiring the insurer to offer and sell to	224
small employers served or to be served by an alliance one or more	225
health benefit plan options for coverage of their eligible	226
employees and the eligible dependents and members of the families	227
of the eligible employees and, if applicable, such members'	228
eligible retirees and the eligible dependents and members of the	229
families of the retirees, subject to such conditions and	230
restrictions as may be set forth or incorporated into the	231
agreement;	232

(2) A brief description of each type of health benefit plan	233
option that is to be so offered and the conditions for the	234
modification, continuation, and termination of the coverage and	235
benefits thereunder;	236

(3) A statement of the eligibility requirements that an	237
employee or retiree must meet in order for the employee or retiree	238
to be eligible to obtain and retain coverage under any health	239
benefit plan option so offered and, if one of such requirements is	240
that an employee must regularly work for a minimum number of hours	241
per week, a statement of such minimum number of hours, which	242
minimum shall not exceed seventeen and one-halftwenty-five hours	243
per week;	244

(4) A description of any pre-existing condition and waiting	245
period rules;	246

(5) A statement of the premium rates or other charges that	247
apply to each health benefit plan option or a formula or method of	248
determining the rates or charges;	249

(6) A provision prescribing the minimum employer contribution	250
toward premiums or other charges required in order to permit a	251
small employer to obtain coverage under a health benefit plan	252
option offered under an alliance program;	253

(7) A provision requiring that each health benefit plan under	254
the alliance program must provide for the continuation of coverage	255
of participants of an enrolled small employer so long as the small	256
employer determines that such person is a qualified beneficiary	257
entitled to such coverage pursuant to Part 6 of Title I of the	258
"Federal Employee Retirement Income Security Act of 1974," 88	259
Stat. 832, 29 U.S.C.A. 1001, and the laws of this state, and	260
regulations or rulings interpreting such provisions. Such coverage	261
provided by the insurer under the plan to participants shall	262
comply with the "Federal Employee Retirement Income Security Act	263
of 1974" and the relevant statutes, regulations, and rulings	264
interpreting that act, including provisions regarding types of	265
coverage to be provided, apportionments of limitations on	266
coverage, apportionments of deductibles, and the rights of	267
qualified beneficiaries to elect coverage options relating to	268
types of coverage and otherwise.	269

(B) An agreement between an alliance and an insurer referred	270
to in division (B) of section 1731.01 of the Revised Code may	271
contain provisions relating to, but not limited to, any of the	272
following:	273

(1) The application and enrollment process for a small	274
employer and related provisions pertaining to historical	275
experience, health statements, and underwriting standards;	276

(2) The minimum number of those employees eligible to be	277
participants that are required to participate in order to permit a	278
small employer to obtain coverage under a health benefit plan	279
option offered under the alliance program, which may vary with the	280
number of employees or those eligible to be participants in	281
respect of the small employer;	282

(3) A procedure for allowing an enrolled small employer to	283
change from one plan option to another under the alliance program,	284
subject to qualifying by size or otherwise under the alliance	285
program;	286

(4) The application of any risk-related pooling or grouping	287
programs and related premiums, conditions, reviews, and	288
alternatives offered by the insurer;	289

(5) The availability of a medicare supplement coverage option	290
for eligible participants who are covered by Parts A and B of	291
medicare, Title XVIII of the "Social Security Act," 49 Stat. 620	292
(1935), 42 U.S.C.A. 301;	293

(6) Relevant experience periods, enrollment periods, and	294
contract periods;	295

(7) Effective dates for coverage of eligible participants;

296

(8) Conditions under which denial or withdrawal of coverage	297
of participants or small employers and their employees may occur	298
by reason of falsification or misrepresentation of material facts	299
or criminal conduct toward the insurer, small employer, or	300
alliance under the program;	301

(9) Premium rate structures, which may be uniform or make	302
provision for age-specific rates, differentials based on number of	303
participants of an enrolled small employer, products and plan	304
options selected, and other factors, rate adjustments based on	305
consumer price indices, utilization, or other relevant factors,	306
notification of rate adjustments, and arbitration;	307

(10) Any responsibilities of the alliance for billing,	308
collection, and transmittal of premiums;	309

(11) Inclusion under the alliance program of small employers	310
that are members of other organizations described in division	311
(A)(1) of section 1731.01 of the Revised Code that contract with	312
the alliance for this purpose, and conditions pertaining to those	313
small employer members and to their employees and retirees, and	314
dependents and family members of those employees or retirees, as	315
applicable under the alliance program;	316

(12) The agreement of the insurer to offer and sell one or	317
more health benefit plans to small employer members of another	318
small employer health care alliance that contracts with the	319
alliance for this purpose;	320

(13) Use of the health benefit plan options of the insurer in	321
the alliance program and use of the names of the alliance and the	322
insurer;	323

(14) Indemnification from claims and liability by reason of	324
acts or omissions of others;	325

(15) OnwershipOwnership, use, availability, and maintenance	326
of confidentiality of data and records relating to the alliance	327
program;	328

(16) Utilization reports to be provided to the alliance by	329
the insurer;	330

(17) Such other provisions as may be agreed upon by the	331
alliance and the insurer to better provide for the articulation,	332
promotion, financing, and operation of the alliance program or a	333
health benefit plan under the program in furtherance of the public	334
purposes stated in section 1731.02 of the Revised Code.	335

(C) Neither an alliance program nor an agreement between an	336
alliance and an insurer is itself a policy or contract of	337
insurance, or a certificate, indorsement, rider, or application	338
forming any part of a policy, contract, or certificate of	339
insurance. Chapters 3905., 3933., and 3959. of the Revised Code do	340
not apply to an alliance program or to an agreement between an	341
alliance and an insurer thereunder, as such, or to the functions	342
of the alliance under an alliance program.	343

Sec. 1731.09. (A) Nothing contained in this chapter is	344
intended to or shall inhibit or prevent the application of the	345
provisions of Chapter 3924. of the Revised Code to any health	346
benefit plan or insurer to which they would otherwise apply in the	347
absence of this chapter, except as otherwise specified in	348
divisions (B) and (C) of this section or unless such application	349
conflicts with the provisions of section 1731.05 of the Revised	350
Code.	351

(B) An insurer may establish one or more separate classes of	352
business solely comprised of one or more alliances. All of the	353
following shall apply to health plans covering small employers in	354
each class of business established pursuant to this division:	355

(1) The premium rate limitations set forth in section 3924.04	356
of the Revised Code apply to each class of business separate and	357
apart from the insurer's other business;	358

(2) For purposes of applying sections 3924.01 to 3924.14 of	359
the Revised Code to a class of business, the base premium rate and	360
midpoint rate shall be determined with respect to each class of	361
business separate and apart from the insurer's other business.	362

(3) The midpoint rate for a class of business shall not	363
exceed the midpoint rate for any other class of business or the	364
insurer's non-alliance business by more than fifteen per cent.	365

(4) The insurer annually shall file with the superintendent	366
of insurance an actuarial certification consistent with section	367
3924.06 of the Revised Code for each class of business	368
demonstrating that the underwriting and rating methods of the	369
insurer do all of the following:	370

(a) Comply with accepted actuarial practices;

371

(b) Are uniformly applied to health benefit plans covering	372
small employers within the class of business;	373

(c) Comply with the applicable provisions of this section and	374
sections 3924.01 to 3924.14 of the Revised Code.	375

(5) An insurer shall apply sections 3924.01 to 3924.14 of the	376
Revised Code to the insurer's non-alliance business and coverage	377
sold through alliances not established as a separate class of	378
business.	379

(6) An insurer shall file with the superintendent a	380
notification identifying any alliance or alliances to be treated	381
as a separate class of business at least sixty days prior to the	382
date the rates for that class of business take effect.	383

(7) Any application for a certificate of authority filed	384
pursuant to section 1731.021 of the Revised Code shall include a	385
disclosure as to whether the alliance will be underwritten or	386
rated as part of a separate class of business.	387

(C) As used in this section:

388

(1) "Class of business" means a group of small employers, as	389
defined in section 3924.01 of the Revised Code, that are enrolled	390
employers in one or more alliances.	391

(2) "Actuarial certification," "base premium rate," and	392
"midpoint rate" have the same meanings as in section 3924.01 of	393
the Revised Code.	394

Sec. 2921.01.  As used in sections 2921.01 to 2921.45 of the	395
Revised Code:	396

(A) "Public official" means any elected or appointed officer,	397
or employee, or agent of the state or any political subdivision,	398
whether in a temporary or permanent capacity, and includes, but is	399
not limited to, legislators, judges, and law enforcement officers.	400

(B) "Public servant" means any of the following:

401

(1) Any public official;

402

(2) Any person performing ad hoc a governmental function,	403
including, but not limited to, a juror, member of a temporary	404
commission, master, arbitrator, advisor, or consultant, except a	405
person who consults for a public agency on matters concerning the	406
business of insurance under Title XXXIX of the Revised Code, as	407
long as the person in advance discloses to the agency the source	408
and the amount of any fees or third party payments the person	409
receives, and the agency approves the receipt of the fees or third	410
party payments;	411

(3) A person who is a candidate for public office, whether or	412
not the person is elected or appointed to the office for which the	413
person is a candidate. A person is a candidate for purposes of	414
this division if the person has been nominated according to law	415
for election or appointment to public office, or if the person has	416
filed a petition or petitions as required by law to have the	417
person's name placed on the ballot in a primary, general, or	418
special election, or if the person campaigns as a write-in	419
candidate in any primary, general, or special election.	420

(C) "Party official" means any person who holds an elective	421
or appointive post in a political party in the United States or	422
this state, by virtue of which the person directs, conducts, or	423
participates in directing or conducting party affairs at any level	424
of responsibility.	425

(D) "Official proceeding" means any proceeding before a	426
legislative, judicial, administrative, or other governmental	427
agency or official authorized to take evidence under oath, and	428
includes any proceeding before a referee, hearing examiner,	429
commissioner, notary, or other person taking testimony or a	430
deposition in connection with an official proceeding.	431

(E) "Detention" means arrest; confinement in any vehicle	432
subsequent to an arrest; confinement in any public or private	433
facility for custody of persons charged with or convicted of crime	434
in this state or another state or under the laws of the United	435
States or alleged or found to be a delinquent child or unruly	436
child in this state or another state or under the laws of the	437
United States; hospitalization, institutionalization, or	438
confinement in any public or private facility that is ordered	439
pursuant to or under the authority of section 2945.37, 2945.371,	440
2945.38, 2945.39, 2945.40, 2945.401, or 2945.402 of the Revised	441
Code; confinement in any vehicle for transportation to or from any	442
facility of any of those natures; detention for extradition or	443
deportation; except as provided in this division, supervision by	444
any employee of any facility of any of those natures that is	445
incidental to hospitalization, institutionalization, or	446
confinement in the facility but that occurs outside the facility;	447
supervision by an employee of the department of rehabilitation and	448
correction of a person on any type of release from a state	449
correctional institution; or confinement in any vehicle, airplane,	450
or place while being returned from outside of this state into this	451
state by a private person or entity pursuant to a contract entered	452
into under division (E) of section 311.29 of the Revised Code or	453
division (B) of section 5149.03 of the Revised Code. For a person	454
confined in a county jail who participates in a county jail	455
industry program pursuant to section 5147.30 of the Revised Code,	456
"detention" includes time spent at an assigned work site and going	457
to and from the work site.	458

(F) "Detention facility" means any public or private place	459
used for the confinement of a person charged with or convicted of	460
any crime in this state or another state or under the laws of the	461
United States or alleged or found to be a delinquent child or	462
unruly child in this state or another state or under the laws of	463
the United States.	464

(G) "Valuable thing or valuable benefit" includes, but is not	465
limited to, a contribution. This inclusion does not indicate or	466
imply that a contribution was not included in those terms before	467
September 17, 1986.	468

(H) "Campaign committee," "contribution," "political action	469
committee," "legislative campaign fund," "political party," and	470
"political contributing entity" have the same meanings as in	471
section 3517.01 of the Revised Code.	472

(I) "Provider agreement" and "medical assistance program"	473
have the same meanings as in section 2913.40 of the Revised Code.	474

Sec. 3923.81.  (A) If a person is covered by a health benefit	475
plan issued by a sickness and accident insurer, health insuring	476
corporation, or multiple employer welfare arrangement and the	477
person is required to pay for health care costs out-of-pocket or	478
with funds from a savings account, the amount the person is	479
required to pay to a health care provider or pharmacy shall not	480
exceed the amount the sickness and accident insurer, health	481
insuring corporation, or multiple employer welfare arrangement	482
would pay under applicable reimbursement rates negotiated with the	483
provider or pharmacy. This division does not preclude a person	484
from reaching an agreement with a health care provider or pharmacy	485
on terms that are more favorable to the person than negotiated	486
reimbursement rates that otherwise would apply as long as the	487
claim submitted reflects the alternative amount negotiated, except	488
that a health care provider or pharmacy shall not waive all or	489
part of a copay or deductible if prohibited by any other provision	490
of the Revised Code. The requirements of this division do not	491
apply to amounts owed to a provider or pharmacy with whom the	492
sickness and accident insurer, health insuring corporation, or	493
multiple employer welfare arrangement has no applicable negotiated	494
reimbursement rate.	495

(B) Each sickness and accident insurer, health insuring	496
corporation, or multiple employer welfare arrangement shall	497
establish and maintain a system whereby a person covered by a	498
health benefit plan may obtain information regarding potential out	499
of pocket costs for services provided by in-network providers.	500

(C) As used in this section:

501

(1) "Health benefit plan" means any policy of sickness and	502
accident insurance or any policy, contract, or agreement covering	503
one or more "basic health care services," "supplemental health	504
care services," or "specialty health care services," as defined in	505
section 1751.01 of the Revised Code, offered or provided by a	506
health insuring corporation or by a sickness and accident insurer	507
or multiple employer welfare arrangement.	508

(2) "Reimbursement rates" means any rates that apply to a	509
payment made by a sickness and accident insurer, health insuring	510
corporation, or multiple employer welfare arrangement for charges	511
covered by a health benefit plan.	512

(3) "Savings account" includes health savings accounts,	513
health reimbursement arrangements, flexible savings accounts,	514
medical savings accounts, and similar accounts and arrangements.	515

Sec. 3924.04.  (A)(1) With respect to any health benefit plan	516
of a carrier and except as otherwise provided in division	517
divisions (A)(2) and (3) of this section, the premium rates	518
charged or offered for a rating period for the same or similar	519
coverage under a health benefit plan covering any small employer	520
with similar case characteristics shall not vary from the	521
applicable midpoint rate by more than thirty-fiveforty per cent	522
of the midpoint rate, as to all health benefit plans issued on or	523
after the effective date of this section.	524

(2) A carrier may apply a low claims discount not to exceed	525
five per cent of the midpoint rate to small employers with	526
favorable claims experience. A premium rate for a rating period	527
may fall outside the range set forth in division (A) of this	528
section as the result of a low claims discount.	529

(3) If the premium rates charged or offered for the same or	530
similar coverage under a health benefit plan covering any small	531
employer with similar case characteristics, as determined by the	532
carrier, exceeds the applicable midpointpremium rate by more than	533
thirty-five pointslimitations described in divisions (A)(1) and	534
(2) of this section, any increase in premium rates for a new	535
rating period shall not exceed the sum of both of the following:	536

(a) Any percentage change in the base premium rate measured	537
from the first day of the prior rating period to the first day of	538
the new rating period;	539

(b) Any adjustment due to change in case characteristics or	540
plan design of the small employer, as determined by the carrier.	541

(3) With respect to any health benefit plan of a carrier that	542
is delivered or issued for delivery prior to the effective date of	543
this section, a premium rate for a rating period may exceed the	544
ranges set forth in divisions (A)(1) and (2) of this section for	545
the eighteen-month period immediately following the effective date	546
of this section. The percentage increase in the premium rate	547
charged to a small employer for a new rating period, however,	548
shall not exceed the sum of the following:	549

(a) Any percentage change in the base premium rate measured	550
from the first day of the prior rating period to the first day of	551
the new rating period;	552

(b) Any adjustment due to a change in case characteristics or	553
plan design of the small employer, as determined by the carrier.	554

(4) For purposes of this section, a small employer carrier	555
shall treat all health benefit plans issued or renewed in the same	556
calendar month as having the same rating period.	557

(B) If a carrier utilizes industry as a case characteristic	558
in establishing premium rates, the rate factor associated with any	559
industry classification shall not vary by more than fifteen per	560
cent from the arithmetic average of the rate factors associated	561
with all industry classifications.	562

(C) Subject to divisions (A) and (B) of this section, any	563
increase in premium rates for a new rating period shall not exceed	564
any percentage change in the base premium rate measured from the	565
first day of the prior rating period to the first day of the new	566
rating period plus fifteen per cent, adjusted on a pro rata basis	567
for rating periods greater or less than one year, of the base	568
premium rate for the new rating period and any adjustments due to	569
a change in case characteristics or plan design of the small	570
employer, as determined by the carrier.	571

(D) The superintendent of insurance may adopt rules in	572
accordance with Chapter 119. of the Revised Code that set forth	573
alternative methods of calculating the premium rates required	574
under this section, which methods result in premium rates that are	575
consistent with, and meet the applicable requirements of, this	576
section. A carrier that utilizes any such method of calculation is	577
deemed to be in compliance with this section.	578

(E) If a carrier has established a separate class of business	579
for one or more small employer health care alliances in accordance	580
with section 1731.09 of the Revised Code, this section shall apply	581
in accordance with section 1731.09 of the Revised Code.	582

Sec. 3924.06. (A) Compliance with the underwriting and	583
rating requirements contained in sections 3924.01 to 3924.14 of	584
the Revised Code shall be demonstrated through actuarial	585
certification. Carriers offering health benefit plans to small	586
employers shall file annually with the superintendent of insurance	587
an actuarial certification stating that the underwriting and	588
rating methods of the carrier do all of the following:	589

(A)(1) Comply with accepted actuarial practices;

590

(B)(2) Are uniformly applied to health benefit plans covering	591
small employers;	592

(C)(3) Comply with the applicable provisions of sections	593
3924.01 to 3924.14 of the Revised Code.	594

(B) If a carrier has established a separate class of business	595
for one or more small employer health care alliances in accordance	596
with section 1731.09 of the Revised Code, this section shall apply	597
in accordance with section 1731.09 of the Revised Code.	598

Sec. 3961.01.  As used in sections 3961.01 to 3961.09 of the	599
Revised Code:	600

(A)(1) "Discount medical plan" means a business arrangement	601
or contract in which a person, in exchange for fees, dues,	602
charges, or other consideration, offers access to members to	603
providers of medical services and the right to receive discounted	604
medical services from those providers.	605

(2) "Discount medical plan" does not include any of the	606
following:	607

(a) A plan that does not require a membership or charge a fee	608
to use the plan's medical card;	609

(b) A plan that offers discounts for only pharmaceutical	610
supplies or prescription drugs, or both, and no other medical	611
services;	612

(c) A plan offered by a sickness and accident insurer that is	613
regulated under Title XXXIX of the Revised Code, a health insuring	614
corporation that is regulated under Title XVII of the Revised	615
Code, or an affiliate of such insurer or corporation if the	616
insurer, corporation, or affiliate discloses in writing in not	617
less than twelve-point type on any applications, advertisements,	618
marketing materials, and brochures describing the plan that the	619
plan is not insurance.	620

(B)(1) "Discount medical plan organization" or "organization"	621
means a person who does business in this state; offers to members	622
access to providers of medical services and the right to receive	623
discounted medical services from those providers; contracts with	624
providers, provider networks, or other discount medical plan	625
organizations to offer discounted medical services to members; and	626
determines the fee members pay to participate in the plan.	627

(2) "Discount medical plan organization" does not include a	628
sickness and accident insurer that is regulated under Title XXXIX	629
of the Revised Code or a health insuring corporation that is	630
regulated under Title XVII of the Revised Code.	631

(C) "Facility" means an institution where medical services	632
are performed, including, but not limited to, a hospital or other	633
licensed inpatient center; ambulatory surgical or treatment	634
center; skilled nursing center; residential treatment center;	635
rehabilitation center; diagnostic, laboratory, and imaging center;	636
and any other health care setting.	637

(D) "Health care professional" means a physician or other	638
health care provider who is licensed, accredited, certified, or	639
otherwise authorized to perform specified medical services within	640
the scope of the person's license, accreditation, certification,	641
or other authorization and performs medical services consistent	642
with the laws of this state.	643

(E)(1) "Marketer" means a person or entity who markets,	644
promotes, sells, or distributes a discount medical plan,	645
including, but not limited to, a private label entity that places	646
its name on and markets or distributes a discount medical plan	647
pursuant to a written agreement with a discount medical plan	648
organization described under section 3961.03 of the Revised Code.	649

(2) "Marketer" does not mean a sickness and accident insurer	650
that is regulated under Title XXXIX of the Revised Code, a health	651
insuring corporation that is regulated under Title XVII of the	652
Revised Code, or an affiliate of such insurer or corporation if	653
the insurer, corporation, or affiliate discloses in writing in not	654
less than twelve-point type on any applications, advertisements,	655
marketing materials, and brochures describing the plan that the	656
plan is not insurance.	657

(F) "Medical services" means any maintenance care of the	658
human body; preventative care for the human body; or care,	659
service, or treatment of an illness or dysfunction of, or injury	660
to, the human body. "Medical services" includes, but is not	661
limited to, physician care, inpatient care, hospital surgical	662
services, emergency services, ambulance services, dental care	663
services, vision care services, pharmaceutical supplies,	664
prescription drugs, mental health services, substance abuse	665
services, chiropractic services, podiatric services, laboratory	666
services, and medical equipment and supplies.	667

(G) "Member" means any individual who pays fees, dues,	668
charges, or other consideration to a discount medical plan	669
organization for access to providers of medical services and the	670
right to receive the benefits of a discount medical plan.	671

(H) "Person" means an individual, corporation, partnership,	672
association, joint venture, joint stock company, trust,	673
unincorporated organization, any similar entity, or any	674
combination of these entities.	675

(I) "Provider" means any health care professional or facility	676
that has contracted, directly or indirectly, with a discount	677
medical plan organization to offer discounted medical services to	678
members.	679

(J) "Provider agreement" means any agreement entered into	680
between a discount medical plan organization and a provider or	681
provider network to offer discounted medical services to members	682
as described in section 3961.02 of the Revised Code.	683

(K) "Provider network" means a person that negotiates,	684
directly or indirectly, with a discount medical plan organization	685
on behalf of more than one provider to offer discounted medical	686
services to members.	687

Sec. 3961.02.  (A) A discount medical plan organization shall	688
not offer to members, or advertise to prospective members,	689
discounted medical services unless the services are offered	690
pursuant to a provider agreement. A discount medical plan	691
organization may enter into a provider agreement directly with a	692
provider, indirectly through a provider network to which a	693
provider belongs, or through another discount medical plan	694
organization that contracts with providers directly or through a	695
provider network.	696

(B) A provider agreement between a discount medical plan	697
organization and a provider shall contain all of the following:	698

(1) A list of medical services and products offered at a	699
discount;	700

(2) The discounted rates for medical services or a fee	701
schedule that reflects the provider's discounted rates;	702

(3) A statement that the provider will not charge members	703
more than the discounted rates described in division (B)(2) of	704
this section.	705

(C) A provider agreement between a discount medical plan	706
organization and a provider network shall require the provider	707
network to do all of the following:	708

(1) Maintain an up-to-date list of the provider network's	709
contracted providers and supply that list to the discount medical	710
plan organization on a monthly basis;	711

(2) Have a written agreement with each provider who offers	712
discounted medical services that contains both of the following:	713

(a) The items listed in division (B) of this section;

714

(b) A grant of authority that allows the provider network to	715
contract with discount medical plan organizations on behalf of the	716
provider.	717

(D) A provider agreement between a discount medical plan	718
organization and another discount medical plan organization shall	719
require that the other discount medical plan organization have	720
provider agreements in place that comply with division (A) of this	721
section and division (B) or (C) of this section, as applicable.	722

(E) A discount medical plan organization shall keep for the	723
duration of the agreement a copy of each provider agreement into	724
which the organization has entered.	725

Sec. 3961.03. (A) Prior to a discount medical plan	726
organization allowing a marketer to market, promote, sell, or	727
distribute a discount medical plan, the organization shall enter	728
into a written agreement with the marketer. This agreement shall	729
prohibit the marketer from using or issuing any advertising,	730
marketing materials, brochures, or discount medical cards without	731
the organization's written approval.	732

(B) A discount medical plan organization is bound by and	733
responsible for a marketer's activities that are within the scope	734
of the marketer's agency relationship with the organization.	735

(C) A discount medical plan organization shall approve in	736
writing all advertisements, marketing materials, brochures, and	737
discount cards prior to a marketer using these materials to	738
market, promote, sell, or distribute the discount medical plan.	739

Sec. 3961.04.  (A) A discount medical plan organization or	740
marketer shall disclose all of the following information in	741
writing in not less than twelve-point type on the first content	742
page of any advertisements, marketing materials, or brochures made	743
available to the public relating to a discount medical plan and	744
with any enrollment forms:	745

(1) A statement that the discount medical plan is not	746
insurance;	747

(2) A statement that the range of discounts for medical	748
services offered under the discount medical plan will vary	749
depending on the type of provider and medical services;	750

(3) A statement that the discount medical plan is prohibited	751
from making members' payments to providers for medical services	752
received under the discount medical plan;	753

(4) A statement that the member is obligated to pay for all	754
discounted medical services received under the discount medical	755
plan;	756

(5) The discount medical plan organization's toll-free	757
telephone number and internet web site address that a member or	758
prospective member may use to obtain additional information about	759
and assistance with the discount medical plan and up-to-date lists	760
of providers participating in the discount medical plan.	761

(B) If a discount medical plan organization's or marketer's	762
initial contact with a prospective or new member is by telephone,	763
the organization or marketer shall disclose all of the information	764
listed in division (A) of this section orally in addition to	765
complying with the written disclosure requirements of that	766
division.	767

(C) In addition to the disclosures required under division	768
(A) of this section, a discount medical plan organization shall	769
provide to each prospective or new member a copy of the terms and	770
conditions of the discount medical plan in a written document at	771
the time of purchase. The document shall be clear and include all	772
of the following information:	773

(1) Name of the member;

774

(2) Benefits provided under the discount medical plan;

775

(3) Any processing fees and periodic charges associated with	776
the discount medical plan, including, but not limited to, if	777
applicable, the procedures for changing the mode of payment and	778
any accompanying additional charges;	779

(4) Any limitations, exclusions, or exceptions regarding the	780
receipt of discount medical plan benefits;	781

(5) Any waiting periods for certain medical services under	782
the discount medical plan;	783

(6) Procedures for obtaining discounts under the discount	784
medical plan, such as requiring members to contact the discount	785
medical plan organization to request that the organization make an	786
appointment with a provider on the member's behalf;	787

(7) Cancellation and refund rights described in section	788
3961.06 of the Revised Code;	789

(8) Membership renewal, termination, and cancellation terms	790
and conditions;	791

(9) Procedures for adding new family members to the discount	792
medical plan;	793

(10) Procedures for filing complaints under the discount	794
medical plan organization's complaint system and a statement	795
explaining that, if the member remains dissatisfied after	796
completing the organization's complaint system, the member may	797
contact the department of insurance;	798

(11) Name, mailing address, toll-free telephone number, and	799
electronic mail address of the discount medical plan organization	800
that a member may use to make inquiries about the discount medical	801
plan, send cancellation notices, and file complaints.	802

(D) A discount medical plan organization shall maintain on an	803
internet web site page an up-to-date list of the names and	804
addresses of the providers with which the organization has	805
contracted directly or indirectly through a provider network. The	806
organization's internet web site address shall be prominently	807
displayed on all of the organization's advertisements, marketing	808
materials, brochures, and discount medical plan cards.	809

(E) When a discount medical plan organization or marketer	810
sells a discount medical plan together with any other product, the	811
organization or marketer shall give to the member, in addition to	812
the other disclosures required under this section, a written	813
statement delineating the fees applicable only to the discount	814
medical plan.	815

Sec. 3961.05.  A discount medical plan organization shall not	816
do any of the following:	817

(A) Except when otherwise permitted in sections 3961.01 to	818
3961.09 of the Revised Code, as a disclaimer of any relationship	819
between discount medical plan benefits and insurance, or in a	820
description of an insurance product connected with a discount	821
medical plan, use the term "insurance" in the organization's	822
advertisements, marketing material, brochures, or discount medical	823
plan cards.	824

(B) Use in the organization's advertisements, marketing	825
material, brochures, or discount medical plan cards the terms	826
"health plan," "coverage," "benefits," "copay," "copayments,"	827
"deductible," "pre-existing conditions," "guaranteed issue,"	828
"premium," "PPO," "preferred provider organization," or any other	829
terms in a manner that could mislead a person into believing that	830
the discount medical plan is health insurance.	831

(C) Make misleading, deceptive, or fraudulent statements or	832
representations regarding the terms or benefits of the discount	833
medical plan, including, but not limited to, statements or	834
representations regarding discounts, range of discounts, or access	835
to those discounts offered under the discount medical plan.	836

(D) Except for hospital services, have restrictions on access	837
to discount medical plan providers, including, but not limited to,	838
waiting and notification periods.	839

(E) Pay providers fees for medical services or collect or	840
accept money from a member to pay a provider for medical services	841
received under the discount medical plan.	842

Sec. 3961.06.  (A) A discount medical plan organization shall	843
permit members to cancel membership in a discount medical plan at	844
any time.	845

(B) If a member gives notice of cancellation within thirty	846
days after the date the member receives the written document	847
described in division (C) of section 3961.04 of the Revised Code	848
for the discount medical plan, the discount medical plan	849
organization, within thirty days of the member giving notice of	850
cancellation, shall fully refund any fees except for a nominal fee	851
associated with enrollment costs that shall not exceed thirty	852
dollars.	853

(C) A discount medical plan organization shall not charge or	854
collect a periodic fee after the member has returned to the	855
organization the member's discount medical plan card or given the	856
organization notice of cancellation.	857

(D) Cancellation of membership in a discount medical plan	858
occurs when the member gives notice of cancellation to the	859
discount medical plan organization or marketer by delivering the	860
notice by hand, depositing the notice in a mailbox if the notice	861
is properly addressed to the discount medical plan organization or	862
marketer and postage is prepaid, or sending an electronic message	863
to the discount medical plan organization's or marketer's	864
electronic message address.	865

(E) A discount medical plan organization shall make a pro	866
rata reimbursement of all periodic fees charged to a member, less	867
nominal fees associated with enrollment or discounts for annual	868
enrollment, if a discount medical plan organization cancels a	869
member's membership for any reason other than the member's failure	870
to pay fees or if a member cancels the member's membership after	871
the first thirty days of membership and the discount medical plan	872
organization charges periodic fees for more than one month.	873

Sec. 3961.07.  (A) The superintendent of insurance may	874
examine or investigate the business and affairs of a discount	875
medical plan organization as the superintendent deems appropriate	876
to protect the interests of the residents of this state.	877

(B) When examining or investigating a discount medical plan	878
organization pursuant to division (A) of this section, the	879
superintendent may do both of the following:	880

(1) Order a discount medical plan organization to produce any	881
records, files, advertising and solicitation materials, lists of	882
providers with which the organization contracted, lists of	883
members, provider agreements described in section 3961.02 of the	884
Revised Code, agreements between a marketer and discount medical	885
plan organization described in section 3961.03 of the Revised	886
Code, or other information;	887

(2) Take statements under oath to determine whether a	888
discount medical plan organization has violated or is violating	889
sections 3961.01 to 3961.08 of the Revised Code or is acting	890
contrary to the public interest.	891

(C)(1) All records and other information concerning a	892
discount medical plan organization obtained by the superintendent	893
or the superintendent's deputies, examiners, assistants, agents,	894
or other employees pursuant to division (B) of this section are	895
confidential and not public records as defined in section 149.43	896
of the Revised Code unless the organization is given notice and	897
opportunity for hearing pursuant to Chapter 119. of the Revised	898
Code concerning the records and other information obtained under	899
division (B) of this section. If no administrative action is	900
initiated with respect to a particular matter about which the	901
superintendent obtained records or other information under	902
division (B) of this section, the records and other information	903
shall remain confidential for three years after the file on the	904
matter is closed.	905

(2) The records and other information described in division	906
(C)(1) of this section shall remain confidential for all purposes	907
except where the superintendent or the superintendent's deputies,	908
examiners, assistants, agents, or other employees appropriately	909
take official action regarding the affairs of the discount medical	910
plan organization or marketer or in connection with actual or	911
potential criminal proceeding.	912

(D) Notwithstanding division (C) of this section, the	913
superintendent may do any of the following:	914

(1) Share records and other information obtained pursuant to	915
division (B) of this section with other persons employed by or	916
acting on behalf of the superintendent; local, state, federal, and	917
international regulatory and law enforcement agencies; local,	918
state, and federal prosecutors; and the national association of	919
insurance commissioners and its affiliates and subsidiaries if the	920
recipient agrees and has authority to agree to maintain the	921
confidential status of the records or other information;	922

(2) Disclose records and other information obtained pursuant	923
to division (B) of this section in furtherance of any regulatory	924
or legal action brought by or on behalf of the superintendent or	925
this state resulting from the exercise of the superintendent's	926
official duties.	927

(E) Notwithstanding divisions (C) and (D) of this section,	928
the superintendent may authorize the national association of	929
insurance commissioners and its affiliates and subsidiaries by	930
agreement to share confidential records and other information	931
obtained pursuant to division (B) of this section with local,	932
state, federal, and international regulatory and law enforcement	933
agencies and local, state, and federal prosecutors if the	934
recipient agrees and has authority to agree to maintain the	935
confidential status of the records and other information.	936

(F) Any applicable privilege or claim of confidentiality is	937
not waived as a result of sharing or disclosing information	938
pursuant to division (D)(1) or (E) of this section.	939

(G) Employees or agents of the department of insurance shall	940
not be required by any court in this state to testify in a civil	941
action if the testimony concerns any matter related to records or	942
other information considered confidential under this section.	943

(H) Nothing in this section shall be construed to limit the	944
superintendent's powers under section 3901.04 of the Revised Code.	945

Sec. 3961.08.  (A) No person shall fail to comply with	946
sections 3961.01 to 3961.09 of the Revised Code. If the	947
superintendent of insurance determines that any person has	948
violated sections 3961.01 to 3961.07 of the Revised Code, the	949
superintendent may take one or more of the following actions:	950

(1) Assess a civil penalty in an amount not to exceed	951
twenty-five thousand dollars per violation if the person knew or	952
should have known of the violation;	953

(2) Assess administrative costs to cover the expenses	954
incurred in the administrative action, including, but not limited	955
to, expenses incurred in the investigation and hearing process.	956
Costs collected under this division shall be paid into the state	957
treasury to the credit of the department of insurance operating	958
fund created in section 3901.021 of the Revised Code.	959

(3) Order corrective actions in lieu of or in addition to the	960
other penalties described in this section, including, but not	961
limited to, suspending civil penalties if a discount medical plan	962
organization complies with the terms of the corrective action	963
order;	964

(4) Order restitution to members.

965

(B) Before imposing a penalty under division (A) of this	966
section, the superintendent shall give a discount medical plan	967
organization notice and opportunity for hearing as described in	968
Chapter 119. of the Revised Code to the extent that Chapter 119.	969
of the Revised Code does not conflict with any of the following	970
service requirements:	971

(1)(a) A notice of opportunity for hearing, a hearing	972
officer's findings and recommendations, or any order issued by the	973
superintendent under division (A) of this section shall be served	974
by certified mail, return receipt requested, to the last known	975
address of a discount medical plan organization. For purposes of	976
division (B) of this section, an organization's last known address	977
is the address listed on the organization's disclosures required	978
under section 3961.04 of the Revised Code.	979

(b) If the certified mail envelope described in division	980
(B)(1)(a) of this section is returned to the superintendent with	981
an endorsement showing that service was refused or that the	982
envelope was unclaimed, the notices, findings and recommendations,	983
and orders described in division (B)(1)(a) of this section and all	984
subsequent notices required under Chapter 119. of the Revised Code	985
may be served by ordinary mail to the discount medical plan	986
organization's last known address. The time period to request an	987
administrative hearing described in Chapter 119. of the Revised	988
Code shall begin to run from the date the ordinary mailing was	989
sent. A certificate of mailing shall evidence any mailings sent by	990
ordinary mail pursuant to this division and shall complete service	991
to the organization unless the ordinary mail envelope is returned	992
to the superintendent with an endorsement showing failure of	993
delivery.	994

(c) If service by ordinary mail as described in division	995
(B)(1)(b) of this section fails, the superintendent may publish a	996
summary of the substantive provisions of the notice, findings and	997
recommendations, or orders described in division (B)(1)(a) of this	998
section once a week for three consecutive weeks in a newspaper of	999
general circulation in the county of the discount medical plan	1000
organization's last known address. The notice shall be considered	1001
served on the date of the third publication.	1002

(d) Any notice required to be served under Chapter 119. of	1003
the Revised Code also shall be served upon the party's attorney by	1004
ordinary mail if the party's attorney has entered an appearance in	1005
the matter.	1006

(e) In lieu of certified or ordinary mail or publication	1007
notice as described in divisions (B)(1)(a), (b), and (c) of this	1008
section, the superintendent may perfect service on a party by	1009
personal delivery of the notice by the superintendent's designee.	1010

(f) Notices regarding the scheduling of hearings and all	1011
other notices not described in division (B)(1)(a) of this section	1012
shall be sent by ordinary mail to the party and the party's	1013
attorney.	1014

(2) A subpoena or subpoena duces tecum from the	1015
superintendent or the superintendent's designee or attorney to a	1016
witness for appearance at a hearing, for the production of	1017
documents or other evidence, or for taking testimony for use at a	1018
hearing shall be served by certified mail, return receipt	1019
requested. The subpoenas described in this division shall be	1020
enforced in the manner described in section 119.09 of the Revised	1021
Code. Nothing in this division shall be construed to limit the	1022
superintendent's other statutory powers to issue subpoenas.	1023

(C)(1) If a violation of sections 3961.01 to 3961.07 of the	1024
Revised Code has caused, is causing, or is about to cause	1025
substantial and material harm, the superintendent may issue a	1026
cease-and-desist order requiring a person to cease and desist from	1027
engaging in a violation.	1028

(2) The superintendent shall, immediately after issuing an	1029
order pursuant to division (C)(1) of this section, serve notice of	1030
the order by certified mail, return receipt requested, or by any	1031
other manner described in division (B) of this section to the	1032
person subject to the order and all other persons involved in the	1033
violation. The notice shall specify the particular act, omission,	1034
practice, or transaction that is the subject of the order and set	1035
a date, not more than fifteen days after the date the order was	1036
issued, for a hearing on the continuation or revocation of the	1037
order. The person subject to the order shall comply with the order	1038
immediately upon receiving the order. After an order is issued	1039
pursuant to division (C)(1) of this section, the superintendent	1040
may publicize and notify all interested parties that a	1041
cease-and-desist order was issued.	1042

(3) Upon application by the person subject to the order and	1043
for good cause, the superintendent may continue the hearing date	1044
described in division (C)(2) of this section. Chapter 119. of the	1045
Revised Code applies to the hearing on the order to the extent	1046
that the chapter does not conflict with the procedures described	1047
in this section. The superintendent shall, within fifteen days	1048
after objections are submitted concerning the hearing officer's	1049
report and recommendations, issue a final order either confirming	1050
or revoking the cease-and-desist order described in division	1051
(C)(1) of this section. The final order may be appealed as	1052
described in section 119.12 of the Revised Code.	1053

(4) The remedy described in division (C) of this section is	1054
cumulative and concurrent with other remedies available under this	1055
section.	1056

(D) If the superintendent has reasonable cause to believe	1057
that an order issued pursuant to this section has been violated in	1058
whole or in part, the superintendent may request the attorney	1059
general to commence any appropriate action against the violator.	1060
In an action described in this division, a court may impose any of	1061
the following penalties:	1062

(1) A civil penalty of not more than twenty-five thousand	1063
dollars per violation;	1064

(2) Injunctive relief;

1065

(3) Restitution;

1066

(4) Any other appropriate relief.

1067

(E) The superintendent shall deposit any penalties assessed	1068
under division (A)(1) or (D) of this section into the state	1069
treasury to the credit of the department of insurance operating	1070
fund created in section 3901.021 of the Revised Code.	1071

Sec. 3961.09.  The superintendent of insurance may adopt	1072
rules in accordance with Chapter 119. of the Revised Code for	1073
purposes of implementing sections 3961.01 to 3961.08 of the	1074
Revised Code.	1075

Section 2. That existing sections 1731.01, 1731.03, 1731.04,	1076
1731.09, 2921.01, 3924.04, and 3924.06 of the Revised Code are	1077
hereby repealed.	1078

Section 3. Sections 1731.03, 1731.09, 3924.04, and 3924.06 of	1079
the Revised Code, as amended by this act, take effect January 1,	1080
2007. Section 3923.81 of the Revised Code, as enacted by this act,	1081
takes effect on the effective date of this act; however, the	1082
amendment of division (B) of that section does not apply to any	1083
facts occurring before six months after the effective date of this	1084
act.	1085