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To amend section 1739.05 and to enact sections | 1 |
1751.68, 1751.69, 3923.84, and 3923.85, of the | 2 |
Revised Code regarding health insurance coverage | 3 |
for orally administered cancer medications and | 4 |
the procedures insured persons are required or | 5 |
permitted to use in acquiring certain | 6 |
non-self-injectable and compounded medications. | 7 |
Section 1. That section 1739.05 be amended and sections | 8 |
1751.68, 1751.69, 3923.84, and 3923.85 of the Revised Code be | 9 |
enacted to read as follows: | 10 |
Sec. 1739.05. (A) A multiple employer welfare arrangement | 11 |
that is created pursuant to sections 1739.01 to 1739.22 of the | 12 |
Revised Code and that operates a group self-insurance program may | 13 |
be established only if any of the following applies: | 14 |
(1) The arrangement has and maintains a minimum enrollment of | 15 |
three hundred employees of two or more employers. | 16 |
(2) The arrangement has and maintains a minimum enrollment of | 17 |
three hundred self-employed individuals. | 18 |
(3) The arrangement has and maintains a minimum enrollment of | 19 |
three hundred employees or self-employed individuals in any | 20 |
combination of divisions (A)(1) and (2) of this section. | 21 |
(B) A multiple employer welfare arrangement that is created | 22 |
pursuant to sections 1739.01 to 1739.22 of the Revised Code and | 23 |
that operates a group self-insurance program shall comply with all | 24 |
laws applicable to self-funded programs in this state, including | 25 |
sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381 | 26 |
to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14, | 27 |
3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, 3923.80, | 28 |
3923.84, 3923.85, 3924.031, 3924.032, and 3924.27 of the Revised | 29 |
Code. | 30 |
(C) A multiple employer welfare arrangement created pursuant | 31 |
to sections 1739.01 to 1739.22 of the Revised Code shall solicit | 32 |
enrollments only through agents or solicitors licensed pursuant to | 33 |
Chapter 3905. of the Revised Code to sell or solicit sickness and | 34 |
accident insurance. | 35 |
(D) A multiple employer welfare arrangement created pursuant | 36 |
to sections 1739.01 to 1739.22 of the Revised Code shall provide | 37 |
benefits only to individuals who are members, employees of | 38 |
members, or the dependents of members or employees, or are | 39 |
eligible for continuation of coverage under section 1751.53 or | 40 |
3923.38 of the Revised Code or under Title X of the "Consolidated | 41 |
Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29 | 42 |
U.S.C.A. 1161, as amended. | 43 |
Sec. 1751.68. (A) Notwithstanding section 3901.71 of the | 44 |
Revised Code and subject to division (B) of this section, no | 45 |
individual or group health insuring corporation policy, contract, | 46 |
or agreement providing basic health care services or prescription | 47 |
drug services that is delivered, issued for delivery, or renewed | 48 |
in this state on or after the effective date of this section and | 49 |
that provides coverage for cancer chemotherapy treatment shall | 50 |
provide coverage for a prescribed, orally administered cancer | 51 |
medication on a less favorable basis than coverage for | 52 |
intravenously administered or injected cancer medications. | 53 |
(B) The prohibition in division (A) of this section includes | 54 |
a prohibition on imposing a coverage limit, copayment, or | 55 |
deductible that is greater, or a prior authorization requirement | 56 |
that is more stringent, than any coverage limit, copayment, | 57 |
deductible, or prior authorization requirement in the policy, | 58 |
contract, or agreement that applies to coverage for intravenously | 59 |
administered or injected cancer medications. | 60 |
Sec. 1751.69. (A) As used in this section: | 61 |
(1) "Dangerous drug" and "pharmacy" have the same meanings | 62 |
as in section 4729.01 of the Revised Code. | 63 |
(2) "Non-self-injectable medication" means a dangerous drug | 64 |
intended for administration by injection that an individual cannot | 65 |
reasonably self-administer. | 66 |
(3) "Retail seller" has the same meaning as in section | 67 |
4729.01 of the Revised Code, and includes a specialty pharmacy or | 68 |
mail order pharmacy. | 69 |
(B) No individual or group health insuring corporation | 70 |
policy, contract, or agreement providing basic health care | 71 |
services or prescription drug services that is delivered, issued | 72 |
for delivery, or renewed in this state on or after the effective | 73 |
date of this section and that provides coverage for | 74 |
non-self-injectable medications, medications that must be | 75 |
compounded immediately prior to administration, or both, shall do | 76 |
either of the following: | 77 |
(1) Require an enrollee to take possession of such a | 78 |
medication from a pharmacy that is a retail seller; | 79 |
(2) Give an enrollee the option of having such a medication | 80 |
delivered directly to the enrollee by mail or any means of | 81 |
commercial shipment. | 82 |
Sec. 3923.84. (A) Notwithstanding section 3901.71 of the | 83 |
Revised Code and subject to division (B) of this section, neither | 84 |
of the following that provides coverage for cancer chemotherapy | 85 |
treatment shall provide coverage for a prescribed, orally | 86 |
administered cancer medication on a less favorable basis than for | 87 |
intravenously administered or injected cancer medications: | 88 |
(1) An individual or group policy of sickness and accident | 89 |
insurance that is delivered, issued for delivery, or renewed in | 90 |
this state on or after the effective date of this section; | 91 |
(2) A public employee benefit plan that is established or | 92 |
modified in this state on or after the effective date of this | 93 |
section. | 94 |
(B) The prohibition in division (A) of this section includes | 95 |
a prohibition on imposing a coverage limit, copayment, or | 96 |
deductible that is greater, or a prior authorization requirement | 97 |
that is more stringent, than any coverage limit, copayment, | 98 |
deductible, or prior authorization requirement in the policy or | 99 |
plan that applies to coverage for intravenously administered or | 100 |
injected cancer medications. | 101 |
Sec. 3923.85. (A) As used in this section: | 102 |
(1) "Dangerous drug" and "pharmacy" have the same meanings | 103 |
as in section 4729.01 of the Revised Code. | 104 |
(2) "Non-self-injectable medication" means a dangerous drug | 105 |
intended for administration by injection that an individual cannot | 106 |
reasonably self-administer. | 107 |
(3) "Retail seller" has the same meaning as in section | 108 |
4729.01 of the Revised Code, and includes a specialty pharmacy or | 109 |
mail order pharmacy. | 110 |
(B)Neither of the following that provides coverage for | 111 |
non-self-injectable medications, medications that must be | 112 |
compounded immediately prior to administration, or both, shall | 113 |
require an insured to take possession of such a medication from a | 114 |
pharmacy that is a retail seller or give an insured the option of | 115 |
having such a medication delivered directly to the insured by mail | 116 |
or any means of commercial shipment: | 117 |
(1) An individual or group policy of sickness and accident | 118 |
insurance that is delivered, issued for delivery, or renewed in | 119 |
this state on or after the effective date of this section; | 120 |
(2) A public employee benefit plan that is established or | 121 |
modified in this state on or after the effective date of this | 122 |
section. | 123 |
Section 2. That existing section 1739.05 of the Revised Code | 124 |
is hereby repealed. | 125 |