As Introduced

129th General Assembly Regular Session 2011-2012

H. B. No. 412

Representatives Antonio, Carney 

Cosponsors: Representatives Pillich, Murray, Fedor, Foley, Boyd, Goyal, Garland, Winburn, Hagan, R., Stinziano, Yuko, Ramos, Williams, Celeste 

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A BILL

To amend sections 124.14 and 3924.01 and to enact

1

sections 3965.01 to 3965.14 of the Revised Code to

2

establish the Ohio Health Benefit Exchange Agency

3

and to establish the Ohio Health Benefit Exchange

4

Program consisting of an exchange for individual

5

coverage and a Small Business Health Options

6

Program.

7

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

Section 1.  That sections 124.14 and 3924.01 be amended and	8
sections 3965.01, 3965.02, 3965.03, 3965.04, 3965.05, 3965.06,	9
3965.07, 3965.08, 3965.09, 3965.10, 3965.11, 3965.12, 3965.13, and	10
3965.14 of the Revised Code be enacted to read as follows:	11

Sec. 124.14.  (A)(1) The director of administrative services	12
shall establish, and may modify or rescind, by rule, a job	13
classification plan for all positions, offices, and employments	14
the salaries of which are paid in whole or in part by the state.	15
The director shall group jobs within a classification so that the	16
positions are similar enough in duties and responsibilities to be	17
described by the same title, to have the same pay assigned with	18
equity, and to have the same qualifications for selection applied.	19
The director shall, by rule, assign a classification title to each	20
classification within the classification plan. However, the	21
director shall consider in establishing classifications, including	22
classifications with parenthetical titles, and assigning pay	23
ranges such factors as duties performed only on one shift, special	24
skills in short supply in the labor market, recruitment problems,	25
separation rates, comparative salary rates, the amount of training	26
required, and other conditions affecting employment. The director	27
shall describe the duties and responsibilities of the class,	28
establish the qualifications for being employed in each position	29
in the class, and file with the secretary of state a copy of	30
specifications for all of the classifications. The director shall	31
file new, additional, or revised specifications with the secretary	32
of state before they are used.	33

The director shall, by rule, assign each classification,	34
either on a statewide basis or in particular counties or state	35
institutions, to a pay range established under section 124.15 or	36
section 124.152 of the Revised Code. The director may assign a	37
classification to a pay range on a temporary basis for a period of	38
six months. The director may establish, by rule adopted under	39
Chapter 119. of the Revised Code, experimental classification	40
plans for some or all employees paid directly by warrant of the	41
director of budget and management. The rule shall include	42
specifications for each classification within the plan and shall	43
specifically address compensation ranges, and methods for	44
advancing within the ranges, for the classifications, which may be	45
assigned to pay ranges other than the pay ranges established under	46
section 124.15 or 124.152 of the Revised Code.	47

(2) The director of administrative services may reassign to a	48
proper classification those positions that have been assigned to	49
an improper classification. If the compensation of an employee in	50
such a reassigned position exceeds the maximum rate of pay for the	51
employee's new classification, the employee shall be placed in pay	52
step X and shall not receive an increase in compensation until the	53
maximum rate of pay for that classification exceeds the employee's	54
compensation.	55

(3) The director may reassign an exempt employee, as defined	56
in section 124.152 of the Revised Code, to a bargaining unit	57
classification if the director determines that the bargaining unit	58
classification is the proper classification for that employee.	59
Notwithstanding Chapter 4117. of the Revised Code or instruments	60
and contracts negotiated under it, these placements are at the	61
director's discretion.	62

(4) The director shall, by rule, assign related	63
classifications, which form a career progression, to a	64
classification series. The director shall, by rule, assign each	65
classification in the classification plan a five-digit number, the	66
first four digits of which shall denote the classification series	67
to which the classification is assigned. When a career progression	68
encompasses more than ten classifications, the director shall, by	69
rule, identify the additional classifications belonging to a	70
classification series. The additional classifications shall be	71
part of the classification series, notwithstanding the fact that	72
the first four digits of the number assigned to the additional	73
classifications do not correspond to the first four digits of the	74
numbers assigned to other classifications in the classification	75
series.	76

(5) The director may establish, modify, or rescind a	77
classification plan for county agencies that elect not to use the	78
services and facilities of a county personnel department. The	79
director shall establish any such classification plan by means of	80
rules adopted under Chapter 119. of the Revised Code. The rules	81
shall include a methodology for the establishment of titles unique	82
to county agencies, the use of state classification titles and	83
classification specifications for common positions, the criteria	84
for a county to meet in establishing its own classification plan,	85
and the establishment of what constitutes a classification series	86
for county agencies. The director may assess a county agency that	87
chooses to use the classification plan a usage fee the director	88
determines. All usage fees the department of administrative	89
services receives shall be paid into the state treasury to the	90
credit of the human resources fund created in section 124.07 of	91
the Revised Code.	92

(B) Division (A) of this section and sections 124.15 and	93
124.152 of the Revised Code do not apply to the following persons,	94
positions, offices, and employments:	95

(1) Elected officials;

96

(2) Legislative employees, employees of the legislative	97
service commission, employees in the office of the governor,	98
employees who are in the unclassified civil service and exempt	99
from collective bargaining coverage in the office of the secretary	100
of state, auditor of state, treasurer of state, and attorney	101
general, and employees of the supreme court;	102

(3) Employees of a county children services board that	103
establishes compensation rates under section 5153.12 of the	104
Revised Code;	105

(4) Any position for which the authority to determine	106
compensation is given by law to another individual or entity;	107

(5) Employees of the bureau of workers' compensation whose	108
compensation the administrator of workers' compensation	109
establishes under division (B) of section 4121.121 of the Revised	110
Code;	111

(6) Employees of the Ohio health benefit exchange program	112
whose compensation the board of the Ohio health benefit exchange	113
agency establishes under division (H) of section 3965.03 of the	114
Revised Code.	115

(C) The director may employ a consulting agency to aid and	116
assist the director in carrying out this section.	117

(D)(1) When the director proposes to modify a classification	118
or the assignment of classes to appropriate pay ranges, the	119
director shall send written notice of the proposed rule to the	120
appointing authorities of the affected employees thirty days	121
before a hearing on the proposed rule. The appointing authorities	122
shall notify the affected employees regarding the proposed rule.	123
The director also shall send those appointing authorities notice	124
of any final rule that is adopted within ten days after adoption.	125

(2) When the director proposes to reclassify any employee so	126
that the employee is adversely affected, the director shall give	127
to the employee affected and to the employee's appointing	128
authority a written notice setting forth the proposed new	129
classification, pay range, and salary. Upon the request of any	130
classified employee who is not serving in a probationary period,	131
the director shall perform a job audit to review the	132
classification of the employee's position to determine whether the	133
position is properly classified. The director shall give to the	134
employee affected and to the employee's appointing authority a	135
written notice of the director's determination whether or not to	136
reclassify the position or to reassign the employee to another	137
classification. An employee or appointing authority desiring a	138
hearing shall file a written request for the hearing with the	139
state personnel board of review within thirty days after receiving	140
the notice. The board shall set the matter for a hearing and	141
notify the employee and appointing authority of the time and place	142
of the hearing. The employee, the appointing authority, or any	143
authorized representative of the employee who wishes to submit	144
facts for the consideration of the board shall be afforded	145
reasonable opportunity to do so. After the hearing, the board	146
shall consider anew the reclassification and may order the	147
reclassification of the employee and require the director to	148
assign the employee to such appropriate classification as the	149
facts and evidence warrant. As provided in division (A)(1) of	150
section 124.03 of the Revised Code, the board may determine the	151
most appropriate classification for the position of any employee	152
coming before the board, with or without a job audit. The board	153
shall disallow any reclassification or reassignment classification	154
of any employee when it finds that changes have been made in the	155
duties and responsibilities of any particular employee for	156
political, religious, or other unjust reasons.	157

(E)(1) Employees of each county department of job and family	158
services shall be paid a salary or wage established by the board	159
of county commissioners. The provisions of section 124.18 of the	160
Revised Code concerning the standard work week apply to employees	161
of county departments of job and family services. A board of	162
county commissioners may do either of the following:	163

(a) Notwithstanding any other section of the Revised Code,	164
supplement the sick leave, vacation leave, personal leave, and	165
other benefits of any employee of the county department of job and	166
family services of that county, if the employee is eligible for	167
the supplement under a written policy providing for the	168
supplement;	169

(b) Notwithstanding any other section of the Revised Code,	170
establish alternative schedules of sick leave, vacation leave,	171
personal leave, or other benefits for employees not inconsistent	172
with the provisions of a collective bargaining agreement covering	173
the affected employees.	174

(2) Division (E)(1) of this section does not apply to	175
employees for whom the state employment relations board	176
establishes appropriate bargaining units pursuant to section	177
4117.06 of the Revised Code, except in either of the following	178
situations:	179

(a) The employees for whom the state employment relations	180
board establishes appropriate bargaining units elect no	181
representative in a board-conducted representation election.	182

(b) After the state employment relations board establishes	183
appropriate bargaining units for such employees, all employee	184
organizations withdraw from a representation election.	185

(F)(1) Notwithstanding any contrary provision of sections	186
124.01 to 124.64 of the Revised Code, the board of trustees of	187
each state university or college, as defined in section 3345.12 of	188
the Revised Code, shall carry out all matters of governance	189
involving the officers and employees of the university or college,	190
including, but not limited to, the powers, duties, and functions	191
of the department of administrative services and the director of	192
administrative services specified in this chapter. Officers and	193
employees of a state university or college shall have the right of	194
appeal to the state personnel board of review as provided in this	195
chapter.	196

(2) Each board of trustees shall adopt rules under section	197
111.15 of the Revised Code to carry out the matters of governance	198
described in division (F)(1) of this section. Until the board of	199
trustees adopts those rules, a state university or college shall	200
continue to operate pursuant to the applicable rules adopted by	201
the director of administrative services under this chapter.	202

(G)(1) Each board of county commissioners may, by a	203
resolution adopted by a majority of its members, establish a	204
county personnel department to exercise the powers, duties, and	205
functions specified in division (G) of this section. As used in	206
division (G) of this section, "county personnel department" means	207
a county personnel department established by a board of county	208
commissioners under division (G)(1) of this section.	209

(2)(a) Each board of county commissioners, by a resolution	210
adopted by a majority of its members, may designate the county	211
personnel department of the county to exercise the powers, duties,	212
and functions specified in sections 124.01 to 124.64 and Chapter	213
325. of the Revised Code with regard to employees in the service	214
of the county, except for the powers and duties of the state	215
personnel board of review, which powers and duties shall not be	216
construed as having been modified or diminished in any manner by	217
division (G)(2) of this section, with respect to the employees for	218
whom the board of county commissioners is the appointing authority	219
or co-appointing authority.	220

(b) Nothing in division (G)(2) of this section shall be	221
construed to limit the right of any employee who possesses the	222
right of appeal to the state personnel board of review to continue	223
to possess that right of appeal.	224

(c) Any board of county commissioners that has established a	225
county personnel department may contract with the department of	226
administrative services, another political subdivision, or an	227
appropriate public or private entity to provide competitive	228
testing services or other appropriate services.	229

(3) After the county personnel department of a county has	230
been established as described in division (G)(2) of this section,	231
any elected official, board, agency, or other appointing authority	232
of that county, upon written notification to the county personnel	233
department, may elect to use the services and facilities of the	234
county personnel department. Upon receipt of the notification by	235
the county personnel department, the county personnel department	236
shall exercise the powers, duties, and functions as described in	237
division (G)(2) of this section with respect to the employees of	238
that elected official, board, agency, or other appointing	239
authority.	240

(4) Each board of county commissioners, by a resolution	241
adopted by a majority of its members, may disband the county	242
personnel department.	243

(5) Any elected official, board, agency, or appointing	244
authority of a county may end its involvement with a county	245
personnel department upon actual receipt by the department of a	246
certified copy of the notification that contains the decision to	247
no longer participate.	248

(6) The director of administrative services may, by rule	249
adopted in accordance with Chapter 119. of the Revised Code,	250
prescribe criteria and procedures for the following:	251

(a) A requirement that each county personnel department, in	252
carrying out its duties, adhere to merit system principles with	253
regard to employees of county departments of job and family	254
services, child support enforcement agencies, and public child	255
welfare agencies so that there is no threatened loss of federal	256
funding for these agencies, and a requirement that the county be	257
financially liable to the state for any loss of federal funds due	258
to the action or inaction of the county personnel department. The	259
costs associated with audits conducted to monitor compliance with	260
division (G)(6)(a) of this section shall be reimbursed to the	261
department of administrative services as determined by the	262
director. All money the department receives for these audits shall	263
be paid into the state treasury to the credit of the human	264
resources fund created in section 124.07 of the Revised Code.	265

(b) Authorization for the director of administrative services	266
to conduct periodic audits and reviews of county personnel	267
departments to guarantee the uniform application of the powers,	268
duties, and functions exercised pursuant to division (G)(2)(a) of	269
this section. The costs of the audits and reviews shall be	270
reimbursed to the department of administrative services as	271
determined by the director by the county for which the services	272
are performed. All money the department receives shall be paid	273
into the state treasury to the credit of the human resources fund	274
created in section 124.07 of the Revised Code.	275

(H) The director of administrative services shall establish	276
the rate and method of compensation for all employees who are paid	277
directly by warrant of the director of budget and management and	278
who are serving in positions that the director of administrative	279
services has determined impracticable to include in the state job	280
classification plan. This division does not apply to elected	281
officials, legislative employees, employees of the legislative	282
service commission, employees who are in the unclassified civil	283
service and exempt from collective bargaining coverage in the	284
office of the secretary of state, auditor of state, treasurer of	285
state, and attorney general, employees of the courts, employees of	286
the bureau of workers' compensation whose compensation the	287
administrator of workers' compensation establishes under division	288
(B) of section 4121.121 of the Revised Code, or employees of an	289
appointing authority authorized by law to fix the compensation of	290
those employees.	291

(I) The director shall set the rate of compensation for all	292
intermittent, seasonal, temporary, emergency, and casual employees	293
in the service of the state who are not considered public	294
employees under section 4117.01 of the Revised Code. Those	295
employees are not entitled to receive employee benefits. This rate	296
of compensation shall be equitable in terms of the rate of	297
employees serving in the same or similar classifications. This	298
division does not apply to elected officials, legislative	299
employees, employees of the legislative service commission,	300
employees who are in the unclassified civil service and exempt	301
from collective bargaining coverage in the office of the secretary	302
of state, auditor of state, treasurer of state, and attorney	303
general, employees of the courts, employees of the bureau of	304
workers' compensation whose compensation the administrator	305
establishes under division (B) of section 4121.121 of the Revised	306
Code, or employees of an appointing authority authorized by law to	307
fix the compensation of those employees.	308

Sec. 3924.01.  As used in sections 3924.01 to 3924.14 of the	309
Revised Code:	310

(A) "Actuarial certification" means a written statement	311
prepared by a member of the American academy of actuaries, or by	312
any other person acceptable to the superintendent of insurance,	313
that states that, based upon the person's examination, a carrier	314
offering health benefit plans to small employers is in compliance	315
with sections 3924.01 to 3924.14 of the Revised Code. "Actuarial	316
certification" shall include a review of the appropriate records	317
of, and the actuarial assumptions and methods used by, the carrier	318
relative to establishing premium rates for the health benefit	319
plans.	320

(B) "Adjusted average market premium price" means the average	321
market premium price as determined by the board of directors of	322
the Ohio health reinsurance program either on the basis of the	323
arithmetic mean of all carriers' premium rates for an OHC plan	324
sold to groups with similar case characteristics by all carriers	325
selling OHC plans in the state, or on any other equitable basis	326
determined by the board.	327

(C) "Base premium rate" means, as to any health benefit plan	328
that is issued by a carrier and that covers at least two but no	329
more than fifty employees of a small employer, the lowest premium	330
rate for a new or existing business prescribed by the carrier for	331
the same or similar coverage under a plan or arrangement covering	332
any small employer with similar case characteristics.	333

(D) "Carrier" means any sickness and accident insurance	334
company or health insuring corporation authorized to issue health	335
benefit plans in this state or a MEWA. A sickness and accident	336
insurance company that owns or operates a health insuring	337
corporation, either as a separate corporation or as a line of	338
business, shall be considered as a separate carrier from that	339
health insuring corporation for purposes of sections 3924.01 to	340
3924.14 of the Revised Code.	341

(E) "Case characteristics" means, with respect to a small	342
employer, the geographic area in which the employees work; the age	343
and sex of the individual employees and their dependents; the	344
appropriate industry classification as determined by the carrier;	345
the number of employees and dependents; and such other objective	346
criteria as may be established by the carrier. "Case	347
characteristics" does not include claims experience, health	348
status, or duration of coverage from the date of issue.	349

(F) "Dependent" means the spouse or child of an eligible	350
employee, subject to applicable terms of the health benefits plan	351
covering the employee.	352

(G) "Eligible employee" means an employee who works a normal	353
work week of twenty-five or more hours. "Eligible employee" does	354
not include a temporary or substitute employee, or a seasonal	355
employee who works only part of the calendar year on the basis of	356
natural or suitable times or circumstances.	357

(H) "Health benefit plan" means any hospital or medical	358
expense policy or certificate or any health plan provided by a	359
carrier, that is delivered, issued for delivery, renewed, or used	360
in this state on or after the date occurring six months after	361
November 24, 1995. "Health benefit plan" does not include policies	362
covering only accident, credit, dental, disability income,	363
long-term care, hospital indemnity, medicare supplement, specified	364
disease, or vision care; coverage under a	365
one-time-limited-duration policy of no longer than six months;	366
coverage issued as a supplement to liability insurance; insurance	367
arising out of a workers' compensation or similar law; automobile	368
medical-payment insurance; or insurance under which benefits are	369
payable with or without regard to fault and which is statutorily	370
required to be contained in any liability insurance policy or	371
equivalent self-insurance.	372

(I) "Late enrollee" means an eligible employee or dependent	373
who enrolls in a small employer's health benefit plan other than	374
during the first period in which the employee or dependent is	375
eligible to enroll under the plan or during a special enrollment	376
period described in section 2701(f) of the "Health Insurance	377
Portability and Accountability Act of 1996," Pub. L. No. 104-191,	378
110 Stat. 1955, 42 U.S.C.A. 300gg, as amended.	379

(J) "MEWA" means any "multiple employer welfare arrangement"	380
as defined in section 3 of the "Federal Employee Retirement Income	381
Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended,	382
except for any arrangement which is fully insured as defined in	383
division (b)(6)(D) of section 514 of that act.	384

(K) "Midpoint rate" means, for small employers with similar	385
case characteristics and plan designs and as determined by the	386
applicable carrier for a rating period, the arithmetic average of	387
the applicable base premium rate and the corresponding highest	388
premium rate.	389

(L) "Pre-existing conditions provision" means a policy	390
provision that excludes or limits coverage for charges or expenses	391
incurred during a specified period following the insured's	392
enrollment date as to a condition for which medical advice,	393
diagnosis, care, or treatment was recommended or received during a	394
specified period immediately preceding the enrollment date.	395
Genetic information shall not be treated as such a condition in	396
the absence of a diagnosis of the condition related to such	397
information.	398

For purposes of this division, "enrollment date" means, with	399
respect to an individual covered under a group health benefit	400
plan, the date of enrollment of the individual in the plan or, if	401
earlier, the first day of the waiting period for such enrollment.	402

(M) "Service waiting period" means the period of time after	403
employment begins before an employee is eligible to be covered for	404
benefits under the terms of any applicable health benefit plan	405
offered by the small employer.	406

(N)(1) "Small employer" means, until January 1, 2016, in	407
connection with a group health benefit plan and with respect to a	408
calendar year and a plan year, an employer who employed an average	409
of at least two but no more than fifty eligible employees on	410
business days during the preceding calendar year and who employs	411
at least two employees on the first day of the plan year and, on	412
and after January 1, 2016, an employer that employed an average of	413
not more than one hundred employees during the preceding calendar	414
year.	415

(2) For purposes of division (N)(1) of this section, all	416
persons treated as a single employer under subsection (b), (c),	417
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	418
100 Stat. 2085, 26 U.S.C.A. 1, as amended, shall be considered one	419
employer. In the case of an employer that was not in existence	420
throughout the preceding calendar year, the determination of	421
whether the employer is a small or large employer shall be based	422
on the average number of eligible employees that it is reasonably	423
expected the employer will employ on business days in the current	424
calendar year. Any reference in division (N) of this section to an	425
"employer" includes any predecessor of the employer. Except as	426
otherwise specifically provided, provisions of sections 3924.01 to	427
3924.14 of the Revised Code that apply to a small employer that	428
has a health benefit plan shall continue to apply until the plan	429
anniversary following the date the employer no longer meets the	430
requirements of this division.	431

(O) "OHC plan" means an Ohio health care plan, which is the	432
basic, standard, or carrier reimbursement plan for small employers	433
and individuals established in accordance with section 3924.10 of	434
the Revised Code.	435

Sec. 3965.01.  (A) The purpose of this chapter is to provide	436
for the establishment of an Ohio health benefit exchange agency	437
and an Ohio health benefit exchange program to facilitate the	438
purchase and sale of qualified health plans in the individual	439
market in this state, and to provide for the establishment of a	440
small business health options program as a part of the Ohio health	441
benefit exchange program to assist qualified small employers in	442
this state in facilitating the enrollment of their employees in	443
qualified health plans offered in the small group market.	444

(B) The Ohio general assembly declares that the following	445
objectives are to be served by this chapter:	446

(1) Extend access to high quality, affordable health plans to	447
all Ohioans;	448

(2) Reduce the number of uninsured Ohioans by creating a	449
cost-effective, user-friendly, and transparent marketplace to help	450
consumers and employers select high quality, affordable health	451
plans and claim available federal tax credits and cost-sharing	452
subsidies;	453

(3) Strengthen the health care delivery system;

454

(4) Guarantee the availability and renewability of health	455
care coverage through the private health insurance market to	456
qualified individuals and qualified small employers;	457

(5) Require that health care service plans and health	458
insurers issuing coverage in the individual and small employer	459
markets compete on the basis of price, quality, and service, not	460
on risk selection;	461

(6) Meet the requirements of the federal act and applicable	462
federal guidance and regulations.	463

Sec. 3965.02.  As used in this chapter:

464

(A) "Carrier" means any sickness and accident insurance	465
company or health insuring corporation authorized to issue health	466
benefit plans in this state.	467

(B) "Exchange" or "exchange program" means the Ohio health	468
benefit exchange program established in section 3965.05 of the	469
Revised Code.	470

(C) "Exchange agency" means the Ohio health benefit exchange	471
agency established in section 3965.03 of the Revised Code.	472

(D) "Federal act" means the federal "Patient Protection and	473
Affordable Care Act of 2010," 124 Stat. 119, as amended by the	474
federal "Health Care and Education Reconciliation Act of 2010,"	475
124 Stat. 1029, and any amendments to those acts, or regulations	476
or guidance issued under those acts.	477

(E) "Health benefit plan" means a policy, contract,	478
certificate, or agreement offered or issued by a carrier to	479
provide, deliver, arrange for, pay for, or reimburse any of the	480
costs of health care services. "Health benefit plan" does not	481
include any of the following:	482

(1) Policies covering only accident or disability income;

483

(2) Coverage issued as a supplement to liability insurance;

484

(3) Liability insurance, including general liability	485
insurance and automobile liability insurance;	486

(4) Workers' compensation or similar insurance;

487

(5) Automobile medical payment insurance;

488

(6) Credit-only insurance;

489

(7) Coverage for on-site medical clinics;

490

(8) Other similar insurance coverage under which benefits for	491
health care services are secondary or incidental to other	492
insurance benefits;	493

(9) Any plan offering the benefits or coverage described in	494
division (D) of section 3965.06 of the Revised Code.	495

(F) "Qualified dental plan" means a limited scope dental plan	496
that has been certified in accordance with section 3965.07 of the	497
Revised Code.	498

(G) "Qualified employer" means a small employer that meets	499
the criteria for a qualified employer established in section	500
3965.11 of the Revised Code.	501

(H) "Qualified health plan" means a health benefit plan that	502
has been certified pursuant to section 3965.06 of the Revised	503
Code.	504

(I) "Qualified individual" means an individual who meets the	505
criteria for a qualified individual established in section 3965.10	506
of the Revised Code.	507

(J) "Secretary" means the secretary of the United States	508
department of health and human services.	509

(K) "SHOP exchange" means the small business health options	510
program established in section 3965.11 of the Revised Code.	511

(L)(1) "Small employer" means, until January 1, 2016, an	512
employer that employed an average of not more than fifty employees	513
during the preceding calendar year and, on and after January 1,	514
2016, an employer that employed an average of not more than one	515
hundred employees during the preceding calendar year.	516

(2) For the purposes of division (L)(1) of this section, all	517
persons treated as a single employer under subsection (b), (c),	518
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	519
100 Stat. 2085, 26 U.S.C. 1, as amended, shall be treated as a	520
single employer. Any reference in division (L) of this section to	521
an "employer" includes any predecessor of the employer. In the	522
case of an employer that was not in existence throughout the	523
preceding calendar year, the determination of whether the employer	524
is a small or large employer shall be based on the average number	525
of eligible employees that the employer is reasonably expected to	526
employ on business days in the current calendar year. All	527
employees shall be counted, including part-time employees and	528
employees who are not eligible for coverage through the employer.	529

Sec. 3965.03.  (A) The Ohio health benefit exchange agency is	530
hereby created. The agency shall have a board of directors	531
consisting of the following members:	532

(1) The following individuals, as part of their appointed	533
roles:	534

(a) The superintendent of insurance, or the superintendant's	535
designee;	536

(b) The director of medicaid, or the director's designee;

537

(c) The director of health, or the director's designee;

538

(2) The following members appointed by the governor following	539
the nomination process described in section 3965.04 of the Revised	540
Code. No more than half shall be members of the same political	541
party, none shall have been employed by or worked as an insurance	542
agent or health care provider in the three years prior to	543
appointment, and all shall be residents of this state. At least	544
one of the six appointed members of the board shall have knowledge	545
of best practices used to address disparities in quality, access,	546
and affordability of health care.	547

(a) One individual who, on account of the individual's	548
present or previous vocation, employment, or affiliations, can be	549
classified as a union representative;	550

(b) One individual who, on account of the individual's	551
present or previous vocation, employment, or affiliations, can be	552
classified as a consumer representative;	553

(c) One individual who, on account of the individual's	554
present or previous vocation, employment, or affiliations, can be	555
classified as a small business representative;	556

(d) One individual who, on account of the individual's	557
present or previous vocation, employment, or affiliations, can be	558
classified as an actuary;	559

(e) One individual who, on account of the individual's	560
present or previous vocation, employment, or affiliations, can be	561
classified as an economist;	562

(f) One individual who, on account of the individual's	563
present or previous vocation, employment, or affiliations, can be	564
classified as an employee benefits specialist.	565

(B) The board shall not include health care providers or	566
their representatives, or insurers or their representatives,	567
brokers, or agents.	568

(C)(1) Of the initial appointments made to the board under	569
division (A)(2) of this section, the governor shall appoint two	570
members to a term ending on June 30, 2013, two members to a term	571
ending on June 30, 2014, and two members to a term ending on June	572
30, 2015. Thereafter, terms of office shall be for three years,	573
with each term ending on the same day of the same month as did the	574
term that it succeeds. Each member shall hold office from the date	575
of the member's appointment until the end of the term for which	576
the member was appointed.	577

(2) The governor shall not appoint any person to more than	578
two full terms of office on the board. This restriction does not	579
prevent the governor from appointing a person to fill a vacancy	580
caused by the death, resignation, or removal of a board member and	581
also appointing that person twice to full terms on the board, or	582
from appointing a person previously appointed to fill less than a	583
full term twice to full terms on the board.	584

(3) Vacancies shall be filled in accordance with division (F)	585
of section 3965.04 of the Revised Code. Any member appointed to	586
fill a vacancy occurring prior to the expiration date of the term	587
for which the member's predecessor was appointed shall hold office	588
as a member for the remainder of that term. A member shall	589
continue in office subsequent to the expiration date of the	590
member's term until a successor takes office or until a period of	591
sixty days has elapsed, whichever occurs first.	592

(D) All members of the board shall receive their reasonable	593
and necessary expenses pursuant to section 126.31 of the Revised	594
Code while engaged in the performance of their duties as members	595
and all members described in division (A)(2) of this section also	596
shall receive an annual salary not to exceed sixty thousand	597
dollars in total, payable on the following basis:	598

(1) Except as provided in division (D)(2) of this section, a	599
member shall receive five thousand dollars during a month in which	600
the member attends one or more meetings of the board and shall	601
receive no payment during a month in which the member attends no	602
meeting of the board.	603

(2) A member may receive no more than sixty thousand dollars	604
per year to compensate the member for attending meetings of the	605
board, regardless of the number of meetings held by the board	606
during a year or the number of meetings in excess of twelve within	607
a year that the member attends.	608

(E) The board shall set meeting dates as necessary to perform	609
the duties of the board under this chapter. The board shall meet	610
at least twelve times per year. A majority of the members shall	611
constitute a quorum.	612

(F) Before entering the duties of office, each appointed	613
member to the board described in division (A)(2) of this section	614
shall take an oath of office as required by sections 3.22 and 3.23	615
of the Revised Code.	616

(G) The board may appoint an advisory committee to the board	617
that shall consist of ten, eleven, or twelve individuals who	618
represent stakeholders, but who shall not vote on the matters	619
before the board. The advisory committee may include all of the	620
following individuals:	621

(1) Representatives of health insuring corporations;

622

(2) Insurance brokers;

623

(3) Health care providers;

624

(4) Consumers, including persons with disabilities;

625

(5) Small business owners;

626

(6) Representatives of organizations or community members	627
that represent ethnic, racial, and rural communities;	628

(7) Others as the board sees fit.

629

(H) The board is responsible for the effective operation of	630
all exchange agency responsibilities and the compliance of the	631
exchange agency and the exchange program with all federal and	632
state rules and regulations. The board shall do all of the	633
following:	634

(1) Exercise all powers reasonably necessary to carry out and	635
comply with the duties, responsibilities, and requirements of this	636
chapter and the federal act;	637

(2) Hire an executive director who shall be in the	638
unclassified civil service. The executive director shall be	639
responsible for the operation of the exchange program.	640

(3) Set the salaries for staff hired by the executive	641
director pursuant to section 3965.05 of the Revised Code that are	642
in amounts reasonably necessary to attract and retain individuals	643
of superior qualifications, publish those salaries in the board's	644
annual budget, and post the board's annual budget on the web site	645
of the exchange agency.	646

(4) Consult with stakeholders relevant to carrying out the	647
activities applicable to the board under this chapter, including	648
all of the following:	649

(a) Health care consumers who are enrolled in health plans;

650

(b) Individuals and entities with experience in facilitating	651
enrollment in health plans;	652

(c) Representatives of small businesses and self-employed	653
individuals;	654

(d) Advocates for enrolling hard-to-reach populations.

655

(5) Develop standardized quality measures to evaluate health	656
benefit plans pursuant to division (A)(7)(g) of section 3965.06 of	657
the Revised Code;	658

(6) Establish a navigator program in accordance with section	659
3965.09 of the Revised Code and select individuals and entities	660
for the navigator program using the criteria listed in that	661
section;	662

(7) Develop privacy policies in accordance with relevant	663
federal and state law, rule, and regulation to protect sensitive	664
applicant and enrollee information;	665

(8) Adopt bylaws for the regulation of its affairs and the	666
conduct of its business.	667

(I) The board may sue and be sued in the name of the exchange	668
agency.	669

Sec. 3965.04.  (A) There is hereby created an exchange agency	670
board of directors nominating council consisting of the following	671
individuals:	672

(1) The chief executive officer of AARP, or that officer's	673
designee;	674

(2) The executive director of the Ohio developmental	675
disabilities council, or the executive director's designee;	676

(3) The director or equivalent representative of the Ohio	677
small business council of the Ohio chamber of commerce, or the	678
director or equivalent representative's designee;	679

(4) The chairperson of the board of directors of the council	680
of smaller enterprises, or the chairperson's designee;	681

(5) The executive director of the universal health care	682
action network of Ohio, or the executive director's designee;	683

(6) The president of the Ohio AFL-CIO, or the president's	684
designee;	685

(7) The president or equivalent representative of the largest	686
public employee organization in this state, or the president or	687
equivalent representative's designee;	688

(8) The president of the health policy institute of Ohio, or	689
the president's designee;	690

(9) The executive director of the Ohio commission on minority	691
health, or the executive director's designee;	692

(10) The chairperson of the department of economics at the	693
Ohio state university, or the chairperson's designee;	694

(11) The president of the Ohio association of health plans,	695
or the president's designee;	696

(12) The president of the Ohio state medical association, or	697
the president's designee;	698

(13) The chief executive officer of the Ohio hospital	699
association, or that officer's designee;	700

(14) An individual selected by the president of the senate;

701

(15) An individual selected by the speaker of the house of	702
representatives.	703

(B) At its first meeting each calendar year, the council	704
shall select from among its members a chairperson and secretary.	705
The council may adopt bylaws governing its proceedings.	706

(C) The council shall keep a record of its proceedings.	707
Special meetings may be called by the chairperson, and shall be	708
called by the chairperson upon receipt of a written request for a	709
meeting signed by two or more members of the council. Written	710
notice of the time and place of each meeting shall be sent to each	711
member of the council. Eight members, or their alternates,	712
constitute a quorum.	713

(D) The council shall:

714

(1) Review and evaluate possible appointees for the office of	715
exchange board director of the Ohio health benefit exchange	716
agency;	717

(2) Consistent with section 3965.03 of the Revised Code, not	718
more than eighty-five nor less than sixty days prior to the	719
expiration of the term of an exchange board director or not more	720
than thirty days after the death of, resignation of, or	721
termination of service by, an exchange board director, provide the	722
governor with a list of four individuals who are, in the judgment	723
of the council, the most fully qualified to accede to the office	724
of exchange board director. The council shall not include the name	725
of an individual upon the list, if the appointment of that	726
individual by the governor would result in more than three	727
appointed members of the board of directors belonging to or being	728
affiliated with the same political party.	729

(E) In reviewing and evaluating possible appointees for the	730
office of exchange board director, the council may accept comments	731
from, cooperate with, and request information from any person. The	732
council may make recommendations to the general assembly	733
concerning changes in legislation to assist the council in the	734
performance of its duties.	735

(F) Within thirty days of receipt of the council's	736
recommendations, the governor shall fill a vacancy occurring in	737
the office of exchange board director by appointment of one of the	738
persons recommended by the council. Nothing in this section shall	739
prevent the governor in the governor's discretion from rejecting	740
all of the nominees of the council and reconvening the council in	741
order to select four additional nominees. However, when the	742
governor has reconvened the council and the council has provided	743
the governor with a second list of four names, the governor shall	744
make the appointment from one of the names on the first list or	745
the second list. Each appointment by the governor shall be subject	746
to the advice and consent of the senate.	747

(G) Members of the council shall be compensated on a per diem	748
basis pursuant to the procedures set forth in section 124.14 of	749
the Revised Code plus reasonable travel expenses. All the expenses	750
of the nominating council shall be paid from moneys appropriated	751
to the exchange agency for that purpose.	752

Sec. 3965.05.  (A) There is hereby created the Ohio health	753
benefit exchange program within the Ohio health benefit exchange	754
agency consisting of an exchange for individual coverage and a	755
SHOP exchange. The executive director of the exchange agency shall	756
be responsible for operating the exchange and shall hire all	757
necessary staff to meet the responsibilities of the executive	758
director as described in this section. All staff hired by the	759
executive director shall be in the classified civil service.	760

(B) The executive director shall do all of the following:

761

(1) Make qualified health plans available to qualified	762
individuals and qualified employers beginning on January 1, 2014;	763

(2) Establish procedures by rule for the certification,	764
recertification, and decertification of health benefit plans as	765
qualified health plans pursuant to section 3965.06 of the Revised	766
Code and consistent with guidelines developed by the secretary	767
under section 1311(c) of the federal act;	768

(3) Provide for the operation of a toll-free telephone	769
hotline to respond to requests for assistance regarding the	770
exchange;	771

(4) Establish enrollment periods, consistent with the	772
requirements of section 1311(c)(6) of the federal act;	773

(5) Maintain a web site through which individuals can enroll	774
in qualified health plans, and through which enrollees and	775
applicants can obtain standardized comparative information on such	776
plans;	777

(6) Assign a rating to each qualified health plan offered	778
through the exchange in accordance with the criteria developed by	779
the secretary under section 1311(c)(3) of the federal act, and	780
determine the level of coverage of each qualified health plan in	781
accordance with regulations issued by the secretary under section	782
1302(d)(2)(A) of the federal act;	783

(7) Ensure that throughout the state a choice of qualified	784
health plans are provided at the catastrophic, bronze, silver,	785
gold, and platinum levels of coverage as those levels are	786
described in sections 1302(d) and (e) of the federal act. A	787
particular plan may be available in one region of the state and	788
not others so long as throughout the state there is a comparable	789
selection of options at each coverage level.	790

(8) Use a standardized format for presenting health benefit	791
options in the exchange, including the use of the uniform outline	792
of coverage established under section 2715 of the "Public Health	793
Service Act," 124 Stat. 132, 42 U.S.C. 300gg-15 (2010);	794

(9) Inform individuals of eligibility requirements for the	795
programs listed in division (B) of section 3965.10 of the Revised	796
Code and enroll all eligible individuals in those programs;	797

(10) Grant certifications attesting that individuals are	798
exempt from the individual responsibility requirement and penalty	799
under section 5000A of the "Internal Revenue Code of 1986," 124	800
Stat. 1215, if individuals meet the criteria listed in division	801
(C) of section 3965.10 of the Revised Code;	802

(11) Establish and make available by electronic means a	803
calculator to determine the actual cost of coverage after	804
application of any premium tax credit under section 36B of the	805
"Internal Revenue Code of 1986," 125 Stat. 168, and any	806
cost-sharing reduction under section 1402 of the federal act;	807

(12) Transfer to the United States secretary of the treasury	808
all of the following:	809

(a) A list of the individuals who are issued a certification	810
under division (B)(10) of this section, including the name and	811
taxpayer identification number of each individual;	812

(b) The name and taxpayer identification number of each	813
individual who was an employee of an employer but who was	814
determined to be eligible for the premium tax credit under section	815
36B of the "Internal Revenue Code of 1986," 125 Stat. 168, because	816
of either of the following reasons:	817

(i) The employer did not provide minimum essential coverage.

818

(ii) The employer provided the minimum essential coverage,	819
but it was determined under section 36B(c)(2)(C) of the "Internal	820
Revenue Code of 1986," 125 Stat. 168, to either be unaffordable to	821
the employee or not to provide the required minimum actuarial	822
value.	823

(c) The name and taxpayer identification number of both of	824
the following:	825

(i) Each individual who notifies the executive director	826
pursuant to section 1411(b)(4) of the federal act that the	827
individual has changed employers;	828

(ii) Each individual who ceases coverage under a qualified	829
health plan during a plan year and the effective date of that	830
cessation.	831

(13) Provide to each employer the name of each employee of	832
the employer described in division (B)(12)(c)(ii) of this section	833
who ceases coverage under a qualified health plan during a plan	834
year and the effective date of the cessation;	835

(14) Review the rate of premium growth within the exchange	836
and outside the exchange, and consider the information in making	837
recommendations to the board of the exchange agency on whether to	838
continue limiting qualified employer status to small employers;	839

(15) Meet the following financial integrity requirements:

840

(a) Keep an accurate accounting of all activities, receipts,	841
and expenditures, and annually submit to the secretary an	842
accounting report as required by section 1313 of the federal act;	843

(b) Conduct an annual fiscal audit;

844

(c) Annually prepare a written report on the implementation	845
and performance of the exchange functions during the preceding	846
fiscal year, including, at a minimum, the manner in which funds	847
were expended and the progress toward, and the achievement of, the	848
requirements of this chapter. This report shall be transmitted to	849
the general assembly and the governor and shall be made available	850
to the public on the web site of the exchange.	851

(d) Fully cooperate with any investigation conducted by the	852
secretary pursuant to the secretary's authority under the federal	853
act and allow the secretary, in coordination with the inspector	854
general of the United States department of health and human	855
services, to do all of the following:	856

(i) Investigate the affairs of the exchange;

857

(ii) Examine the properties and records of the exchange;

858

(iii) Require periodic reports in relation to the activities	859
undertaken by the exchange.	860

(e) In carrying out the activities of the exchange under this	861
chapter, not use any funds intended for the administrative and	862
operational expenses of the exchange for staff retreats,	863
promotional giveaways, excessive executive compensation, or	864
promotion of federal or state legislative and regulatory	865
modifications.	866

(16) Provide referrals to any applicable office of health	867
insurance consumer assistance or health insurance ombudsman	868
established under section 2793 of the "Public Health Service Act,"	869
124 Stat. 138, 42 U.S.C. 300gg-93 (2010), or the department of	870
insurance for any enrollee with a grievance, complaint, or	871
question regarding the enrollee's health plan, coverage, or a	872
determination under that plan or coverage;	873

(17) Market and publicize the availability of health care	874
coverage and federal subsidies through the exchange including	875
efforts to reach hard-to-reach populations;	876

(18) Before January 1, 2019, conduct an ongoing study of	877
exchange activities and the enrollees in qualified health plans	878
offered through the exchange, including all of the following:	879

(a) A survey of the cost and affordability of insurance	880
provided under both the exchange for individual coverage and the	881
SHOP exchange;	882

(b) The number of physicians by area and specialty who are	883
not taking or accepting new patients who are enrolled in qualified	884
health plans through the exchange;	885

(c) The adequacy of provider networks of qualified health	886
plans.	887

(19) Collaborate with agencies and departments of this state,	888
including the department of job and family services and the	889
department of insurance, to allow an individual to remain enrolled	890
with the individual's carrier and provider network if the	891
individual loses eligibility for premium tax credits and becomes	892
eligible for medicaid, or loses eligibility for medicaid and	893
becomes eligible for premium tax credits through the exchange;	894

(20) Ensure that the privacy of applicants and enrollees in	895
the exchange is protected by enforcing the privacy policies	896
developed by the board of the exchange agency pursuant to division	897
(H)(7) of section 3965.03 of the Revised Code.	898

(C) The executive director may do any of the following:

899

(1) Contract with an eligible entity for any of the functions	900
of the exchange described in this chapter, including the	901
department of job and family services or an entity that has	902
experience in individual and small group health insurance, benefit	903
administration or other experience relevant to the	904
responsibilities to be assumed by the entity. A carrier or an	905
affiliate of a carrier is not an eligible entity.	906

(2) Enter into information-sharing agreements with federal	907
and state agencies and departments and other state health benefit	908
exchange agencies to carry out the responsibilities of the	909
exchange under this chapter, provided those agreements include	910
adequate protections with respect to the confidentiality of the	911
information to be shared and comply with all state and federal	912
laws, rules, and regulations.	913

(3) Make available supplemental coverage for enrollees of the	914
exchange to the extent permitted by the federal act, provided that	915
funds in the Ohio health benefit exchange operating fund	916
established in section 3965.12 of the Revised Code are not used to	917
pay the cost of that coverage. Any supplemental coverage offered	918
in the exchange shall be subject to the charge imposed on	919
qualified health plans under section 3965.12 of the Revised Code.	920

(D) Neither the executive director nor any carrier offering a	921
health benefit plan through the exchange shall do either of the	922
following:	923

(1) Make available on the exchange any health plan that is	924
not a qualified health plan;	925

(2) Charge an individual a fee or penalty for termination of	926
coverage if the individual enrolls in another type of minimum	927
essential coverage because the individual has become newly	928
eligible for that coverage or because the individual's	929
employer-sponsored coverage has become affordable under the	930
standards of section 36B(c)(2)(C) of the "Internal Revenue Code of	931
1986," 125 Stat. 168.	932

(E) All data collection performed by the executive director	933
pursuant to this chapter shall include demographic information,	934
including racial and ethnic information as specified by the	935
executive director in rules adopted in accordance with section	936
3965.13 of the Revised Code.	937

Sec. 3965.06.  (A) The executive director of the exchange may	938
certify a health benefit plan as a qualified health plan if all of	939
the following conditions are met:	940

(1) The plan provides the essential health benefits package	941
described in section 1302(a) of the federal act, except that the	942
plan is not required to provide essential benefits that duplicate	943
the minimum benefits of qualified dental plans, as provided in	944
section 3965.07 of the Revised Code, if both of the following are	945
true:	946

(a) The executive director has determined that at least one	947
qualified dental plan is available to supplement the qualified	948
health plan's coverage.	949

(b) The carrier makes prominent disclosure at the time it	950
offers the plan, in a form approved by the executive director,	951
that the plan does not provide the full range of essential	952
pediatric benefits, and that qualified dental plans providing	953
those benefits and other dental benefits not covered by the plan	954
are offered through the exchange.	955

(2) The premium rates and contract language have been	956
approved by the superintendent of insurance.	957

(3) The plan provides at least a bronze level of coverage, as	958
determined pursuant to division (B)(6) of section 3965.05 of the	959
Revised Code unless the plan is certified as a qualified	960
catastrophic plan, which will only be offered to individuals	961
eligible for catastrophic coverage.	962

(4) The plan's cost-sharing requirements do not exceed the	963
limits established under section 1302(c)(1) of the federal act,	964
and, if the plan is offered through the SHOP exchange, the plan's	965
deductible does not exceed the limits established under section	966
1302(c)(2) of the federal act.	967

(5) The carrier offering the plan meets all of the following	968
criteria:	969

(a) The carrier is licensed and in good standing to offer	970
health insurance coverage in this state.	971

(b) The carrier offers at least one qualified catastrophic	972
health plan, at least one qualified health plan in the bronze	973
level, at least one qualified health plan in the silver level, at	974
least one qualified health plan in the gold level, and at least	975
one qualified health plan in the platinum level, as determined by	976
the executive director pursuant to division (B)(6) of section	977
3965.05 of the Revised Code, through the SHOP exchange or the	978
exchange for individual coverage or both if the carrier	979
participates in both the SHOP exchange and the exchange for	980
individual coverage.	981

(c) The carrier charges the same premium rate for each	982
qualified health plan without regard to whether the plan is	983
offered through the exchange and without regard to whether the	984
plan is offered directly from the carrier or through an insurance	985
agent.	986

(d) The carrier does not charge any fee or penalty for	987
termination of coverage in violation of division (D)(2) of section	988
3965.05 of the Revised Code.	989

(e) The carrier complies with the regulations developed by	990
the secretary under section 1311(d) of the federal act and such	991
other requirements as the executive director may establish.	992

(6) The plan meets the requirements of certification as	993
established by rule pursuant to division (B)(2) of section 3965.05	994
of the Revised Code and by the secretary under section 1311(c) of	995
the federal act.	996

(7) The executive director determines that making the plan	997
available through the exchange is in the interest of qualified	998
individuals and qualified employers in this state. In making such	999
a determination, the executive director shall consider all of the	1000
following:	1001

(a) Plans should not make use of marketing practices that	1002
would discourage enrollment by people with significant health	1003
needs.	1004

(b) Plans must provide a sufficient choice of providers and,	1005
where available, must include essential community providers that	1006
serve low-income, medically underserved individuals.	1007

(c) Plans must be accredited by a recognized accreditation	1008
organization, or achieve accreditation from a recognized	1009
accreditation organization within a time period defined by the	1010
board of the exchange agency, based on a review of their clinical	1011
quality, patient experience, access, utilization management,	1012
quality assurance, provider credentialing, complaints and appeals	1013
processes, network adequacy and access, and patient information	1014
programs.	1015

(d) Plans must have a quality improvement strategy.

1016

(e) Plans must use a uniform enrollment form for individuals	1017
and small employers.	1018

(f) Plans must use a standard format for presenting plan	1019
options.	1020

(g) Plans must provide information about their performance on	1021
standardized quality measures as determined by the board of the	1022
exchange agency under division (H)(5) of section 3965.03 of the	1023
Revised Code to enrollees and prospective enrollees.	1024

(h) Plans must report annually to the federal government on	1025
the quality of their pediatric care.	1026

(8) The plan does not offer benefits or coverage described in	1027
division (D) of this section.	1028

(B) The executive director shall not exclude a health benefit	1029
plan from certification for any of the following reasons:	1030

(1) On the basis that the plan is a fee-for-service plan;

1031

(2) Through the imposition of premium price controls by the	1032
exchange;	1033

(3) On the basis that the health benefit plan provides	1034
treatments necessary to prevent patients' deaths in circumstances	1035
the executive director determines are inappropriate or too costly.	1036

(C) The executive director shall require each carrier seeking	1037
certification of a plan as a qualified health plan to do all of	1038
the following:	1039

(1) Submit a justification to the executive director for any	1040
premium increase before implementation of that increase;	1041

(2) Prominently post any information regarding a premium	1042
increase on its web site. The executive director shall take this	1043
information, along with the information and the recommendations	1044
provided to the exchange by the secretary under section 2794(b) of	1045
the "Public Health Service Act," 124 Stat. 139, 42 U.S.C. 300gg-94	1046
(2010), into consideration when determining whether to allow the	1047
carrier to make plans available through the exchange.	1048

(3) Make available to the public, in language that the	1049
intended audience, including individuals with limited English	1050
proficiency, can readily understand, and submit to the exchange,	1051
the secretary, and the superintendent of insurance, accurate and	1052
timely disclosure of all of the following information:	1053

(a) Claims payment policies and practices;

1054

(b) Periodic financial disclosures;

1055

(c) Data on enrollment, disenrollment, the number of claims	1056
that are denied, and rating practices;	1057

(d) Information on cost-sharing and payments with respect to	1058
any out-of-network coverage;	1059

(e) Information on enrollee and participant rights under	1060
Title I of the federal act;	1061

(f) Other information as determined appropriate by the	1062
secretary pursuant to section 1303 of the federal act.	1063

(4) Permit individuals to learn, in a timely manner upon the	1064
request of the individual, the amount of cost-sharing, including	1065
deductibles, copayments, and coinsurance, under the individual's	1066
plan or coverage that the individual would be responsible for	1067
paying with respect to the furnishing of a specific item or	1068
service by a participating provider. At a minimum, this	1069
information shall be made available to the individual through a	1070
web site and through other means for individuals without access to	1071
the internet.	1072

(D) The executive director shall not consider any health	1073
benefit plan for certification as a qualified health plan if the	1074
health benefit plan includes any of the following:	1075

(1) Any of the following benefits if they are provided under	1076
a separate policy, certificate, or contract of insurance or are	1077
otherwise not an integral part of the plan:	1078

(a) Limited scope dental or vision benefits;

1079

(b) Benefits for long-term care, nursing home care, home	1080
health care, or community-based care;	1081

(c) Other similar, limited benefits specified in federal	1082
regulations issued pursuant to the "Health Insurance Portability	1083
and Accountability Act of 1996," 110 Stat. 1936 (1996).	1084

(2) Either of the following benefits if the benefits are	1085
provided under a separate policy, certificate, or contract of	1086
insurance, there is no coordination between the provision of the	1087
benefits and any exclusion of benefits under any health benefit	1088
plan maintained by the same carrier, and the benefits are paid	1089
with respect to an event without regard to whether benefits are	1090
provided with respect to such an event under any health benefit	1091
plan maintained by the same carrier:	1092

(a) Coverage only for a specified disease or illness;

1093

(b) Hospital indemnity or other fixed indemnity insurance.

1094

(3) Any of the following if offered as a separate policy,	1095
certificate, or contract of insurance:	1096

(a) Medicare supplemental health insurance as defined under	1097
section 1882(g)(1) of the "Social Security Act," 124 Stat. 460, 42	1098
U.S.C. 1395ss (2010);	1099

(b) Coverage supplemental to the coverage provided under	1100
chapter 55 of Title 10 of the United States Code;	1101

(c) Similar supplemental coverage provided to coverage under	1102
a group health plan.	1103

(E) The executive director shall not exempt any carrier	1104
seeking certification of a qualified health plan, regardless of	1105
the type or size of the carrier, from state licensure or solvency	1106
requirements and shall apply the criteria of this section in a	1107
manner that assures a level playing field between or among	1108
carriers participating in the exchange.	1109

Sec. 3965.07.  (A) The executive director may certify a	1110
dental plan as a qualified dental plan if all of the following	1111
conditions are met:	1112

(1) The plan provides limited scope dental benefits that are	1113
offered separately from any qualified health plan.	1114

(2) The plan does not substantially duplicate the benefits	1115
typically offered by health benefit plans without dental coverage.	1116

(3) The plan includes, at a minimum, the essential pediatric	1117
dental benefits prescribed by the secretary pursuant to section	1118
1302(b)(1)(J) of the federal act, and such other dental benefits	1119
as the executive director or the secretary may specify by rule or	1120
regulation.	1121

(B) The provisions of this chapter that are applicable to	1122
qualified health plans shall also apply to qualified dental plans	1123
to the extent relevant with the following exceptions:	1124

(1) A carrier that is licensed to offer dental coverage need	1125
not be licensed to offer other health benefits.	1126

(2) Carriers may jointly offer a comprehensive plan through	1127
the exchange in which the dental benefits are provided by a	1128
carrier through a qualified dental plan and the other benefits are	1129
provided by a carrier through a qualified health plan, provided	1130
that the plans are priced separately and are also made available	1131
for purchase separately at the same price.	1132

(C) The executive director may adopt additional rules	1133
concerning qualified dental health plans.	1134

Sec. 3965.08.  (A) Health plans that are certified as	1135
qualified health plans pursuant to section 3965.06 of the Revised	1136
Code and dental plans that are certified as qualified dental plans	1137
pursuant to section 3965.07 of the Revised Code may bid to	1138
participate in the exchange for individual coverage and the SHOP	1139
exchange. Bidding plans will be scored by the executive director	1140
of the exchange based on the following criteria:	1141

(1) The cost of the plan to individuals in terms of premiums	1142
and typical out-of-pocket expenses;	1143

(2) The carrier's overall offering and plan design. Preferred	1144
features of health benefit plans include the following:	1145

(a) Use of a select, high-performance network;

1146

(b) Centers of excellence for complex conditions or	1147
procedures;	1148

(c) Innovative pharmacy management;

1149

(d) Active consumer engagement;

1150

(e) Wellness incentives and management;

1151

(f) Preventive and flex benefits for chronic conditions.

1152

(3) Use of multilingual community outreach or nontraditional	1153
media outlets to reach hard-to-reach communities for marketing	1154
purposes;	1155

(4) The ability of the plan to confirm its compliance with	1156
various program rules and reporting requirements;	1157

(5) The design of the plan's enrollment process, including	1158
the following considerations:	1159

(a) Level of burden to the consumer;

1160

(b) Ease of use with regard to populations that may	1161
experience barriers to enrollment such as the disabled and those	1162
with limited English language proficiency.	1163

(6) A determination of whether including a given plan in the	1164
exchange will encourage a robust system of regional plans.	1165

(B) After consideration of the criteria listed in division	1166
(A) of this section, the executive director shall select qualified	1167
health plans and qualified dental plans to participate in the	1168
exchange. There shall not be a set minimum or maximum number of	1169
qualified health or dental plans that are required to exist in the	1170
exchange.	1171

(C) In the course of selectively contracting for health care	1172
coverage, the executive director shall do both of the following:	1173

(a) Seek to contract with carriers so as to provide health	1174
care coverage choices that offer the optimal combination of	1175
choice, value, quality, and service;	1176

(b) Maintain a robust system of regional plans.

1177

Sec. 3965.09.  (A) The board of the exchange agency shall	1178
establish a navigator program in accordance with section 1311(i)	1179
of the federal act, designed to advise individual consumers and	1180
employers on the use of the exchange.	1181

(B) The board shall select individuals and entities to be	1182
part of the navigator program. To be considered for a grant under	1183
the navigator program, an individual or entity shall meet all of	1184
the following criteria:	1185

(1) The individual or entity shall demonstrate to the board	1186
that the individual or entity has existing relationships or could	1187
readily establish relationships with consumers, employers and	1188
employees, or self-employed individuals, likely to be qualified to	1189
enroll in a qualified health plan;	1190

(2) The individual or entity shall not be a health insurance	1191
issuer or receive any compensation, either directly or indirectly,	1192
from any health insurance issuer in connection with the enrollment	1193
of any qualified individuals or employees of a qualified employer	1194
in a qualified health plan;	1195

(3) The individual or entity shall be capable of carrying out	1196
the duties listed in division (C) of this section.	1197

(C) Navigators shall do all of the following:

1198

(1) Conduct public education activities to raise awareness of	1199
the availability of qualified health plans;	1200

(2) Distribute fair and impartial information concerning	1201
enrollment in qualified health plans, and the availability of	1202
premium tax credits under section 36B of the "Internal Revenue	1203
Code of 1986," 125 Stat. 168, and cost-sharing reductions under	1204
section 1402 of the federal act;	1205

(3) Facilitate enrollment in qualified health plans;

1206

(4) Provide referrals to any applicable office of health	1207
insurance consumer assistance or health insurance ombudsman	1208
established under section 2793 of the "Public Health Service Act,"	1209
124 Stat. 138, 42 U.S.C. 300gg-93 (2010), or the department of	1210
insurance, for any enrollee with a grievance, complaint, or	1211
question regarding their health benefit plan or coverage or a	1212
determination under that plan or coverage;	1213

(5) Provide information in a manner that is culturally and	1214
linguistically appropriate to the needs of the population being	1215
served by the exchange.	1216

(D) The board shall award grants to individuals and entities	1217
approved by the board to perform work as navigators in order to	1218
fund the required duties described in division (C) of this	1219
section. Funds for grants shall be withdrawn from the Ohio health	1220
benefit exchange operating fund established in section 3965.12 of	1221
the Revised Code.	1222

Sec. 3965.10.  (A) Only qualified individuals shall be	1223
permitted to purchase health insurance through the exchange. A	1224
qualified individual is an individual, including a minor, who	1225
meets all of the following criteria:	1226

(1) The individual is seeking to enroll in a qualified health	1227
plan offered to individuals through the exchange.	1228

(2) The individual resides in this state.

1229

(3) The individual is not incarcerated at the time of	1230
enrollment, other than incarceration pending the disposition of	1231
charges.	1232

(4) The individual is, and is reasonably expected to be, for	1233
the entire period for which enrollment is sought, a citizen or	1234
national of the United States, or an alien lawfully present in the	1235
United States.	1236

(B) If the executive director of the exchange program	1237
determines that an individual seeking to purchase health insurance	1238
through the exchange is eligible for the medicaid program under	1239
Title XIX of the "Social Security Act," 124 Stat. 328, 42 U.S.C.	1240
1396 (2010), the children's health insurance program under Title	1241
XXI of the "Social Security Act," 111 Stat. 552, 42 U.S.C. 1397aa	1242
(1997), or any applicable state or local public program, the	1243
executive director shall enroll the individual in that program.	1244

(C) An individual shall be exempt from the individual	1245
responsibility requirement under section 5000A of the "Internal	1246
Revenue Code of 1986," 124 Stat. 1215, or from the penalty imposed	1247
by that section for either of the following reasons:	1248

(1) There is no affordable qualified health plan available	1249
through the exchange, or the individual's employer, covering the	1250
individual.	1251

(2) The individual meets the requirements for any other such	1252
exemption from the individual responsibility requirement or	1253
penalty.	1254

Sec. 3965.11.  (A) As a part of the exchange there shall	1255
exist a SHOP exchange through which qualified employers may access	1256
coverage for their employees, and that shall enable any qualified	1257
employer to specify a level of coverage so that any of its	1258
employees may enroll in any qualified health plan offered through	1259
the SHOP exchange at the specified level of coverage.	1260

(B) Only qualified employers shall be permitted to	1261
participate in the SHOP exchange. A qualified employer is a small	1262
employer that elects to make its full-time employees eligible for	1263
one or more qualified health plans offered through the SHOP	1264
exchange, and at the option of the employer, some or all of its	1265
part-time employees, provided that the employer meets either of	1266
the following criteria:	1267

(1) The employer has its principal place of business in this	1268
state and elects to provide coverage through the SHOP exchange to	1269
all of its eligible employees, wherever employed;	1270

(2) The employer elects to provide coverage through the SHOP	1271
exchange to all of its eligible employees who are principally	1272
employed in this state.	1273

(C) If an employer that makes enrollment in qualified health	1274
plans available to its employees through the SHOP exchange would	1275
cease to be a small employer by reason of an increase in the	1276
number of its employees, the employer shall continue to be treated	1277
as a small employer for purposes of this chapter as long as it	1278
continuously makes enrollment through the SHOP exchange available	1279
to its employees.	1280

Sec. 3965.12.  (A)(1) The exchange agency may charge	1281
assessments or user fees to carriers or otherwise may generate	1282
funding necessary to support its operations and the operations of	1283
the exchange.	1284

(2) All funds collected by the exchange agency pursuant to	1285
division (A)(1) of this section shall be paid into the state	1286
treasury to the credit of the Ohio health benefit exchange	1287
operating fund, which is hereby created.	1288

(B) The exchange agency shall publish the average costs of	1289
licensing, regulatory fees, and any other payments required by the	1290
exchange agency and the exchange, and the administrative costs of	1291
the exchange agency and the exchange, on a web site to educate	1292
consumers on such costs. This information shall include	1293
information on monies lost to waste, fraud, and abuse.	1294

Sec. 3965.13.  The board of the exchange agency and the	1295
executive director of the exchange may adopt rules to implement	1296
the provisions of this chapter. Rules adopted pursuant to this	1297
section shall not conflict with or prevent the application of	1298
regulations promulgated by the secretary under the federal act.	1299

Sec. 3965.14.  Nothing in this chapter, and no action taken	1300
by the board of the exchange agency or the executive director of	1301
the exchange pursuant to this chapter, shall be construed to	1302
preempt or supersede the authority of the superintendent of	1303
insurance to regulate the business of insurance within this state.	1304
Except as expressly provided to the contrary in this chapter, all	1305
carriers offering qualified health plans in this state shall	1306
comply fully with all applicable health insurance laws of this	1307
state and rules adopted and orders issued by the superintendent.	1308

Section 2.  That existing sections 124.14 and 3924.01 of the	1309
Revised Code are hereby repealed.	1310

Section 3. Within ninety days after the effective date of	1311
this act, the exchange agency board of directors nominating	1312
council established in section 3965.04 of the Revised Code as	1313
enacted in this act shall produce two, three, or four nominees for	1314
each position described in division (A)(2) of section 3965.03 of	1315
the Revised Code. Following nomination, the Governor shall appoint	1316
the members described in that division to the board of the Ohio	1317
Health Benefit Exchange Agency in accordance with division (F) of	1318
section 3965.04 of the Revised Code as enacted in this act. At the	1319
time of appointment, the Governor shall determine which members of	1320
the board shall serve the terms described in division (C)(1) of	1321
section 3965.03 of the Revised Code. For each subsequent	1322
nomination period, the nominating council shall produce four	1323
nominees for each position as required by division (D)(2) of	1324
section 3965.04 of the Revised Code.	1325