As Concurred by the House

130th General Assembly Regular Session 2013-2014

Am. Sub. H. B. No. 201

Representative Butler 

Cosponsors: Representatives Adams, J., Terhar, Thompson, Hayes, Adams, R., Amstutz, Anielski, Beck, Bishoff, Blair, Blessing, Budish, Burkley, Conditt, Green, Hood, Huffman, Letson, Milkovich, Perales, Retherford, Sykes, Winburn Speaker Batchelder 

Senators Burke, Coley, Eklund, Jordan, Patton, Seitz 

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A BILL

To amend sections 1739.061, 1751.14, 1751.69,

1

3923.022, 3923.24, 3923.241, 3923.281, 3923.57,

2

3923.58, 3923.601, 3923.65, 3923.83, 3923.85,

3

3924.01, and 5301.36 and to enact sections

4

505.377, 737.082, 737.222, and 5301.361 of the

5

Revised Code to make changes relative to entries

6

of satisfaction, to clarify the status of

7

volunteer firefighters for purposes of the Patient

8

Protection and Affordable Care Act, to make

9

changes regarding coverage for a dependent child

10

under a parent's health insurance plan and the

11

hours of work needed to qualify for coverage under

12

a small employer health benefit plan, to increase

13

the duration of the health insurance considered to

14

be short-term under certain insurance laws, and to

15

make changes to the chemotherapy parity law.

16

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

Section 1. That sections 1739.061, 1751.14, 1751.69,	17
3923.022, 3923.24, 3923.241, 3923.281, 3923.57, 3923.58, 3923.601,	18
3923.65, 3923.83, 3923.85, 3924.01, and 5301.36 be amended and	19
sections 505.377, 737.082, 737.222, and 5301.361 of the Revised	20
Code be enacted to read as follows:	21

Sec. 505.377.  A volunteer firefighter appointed pursuant to	22
this chapter is a bona fide volunteer and not an employee for	23
purposes of section 513 of the "Patient Protection and Affordable	24
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	25
providing those fire protection services, the volunteer receives	26
any of the benefits provided in Chapter 146., 4121., or 4123. or	27
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	28
Code.	29

Sec. 737.082.  A volunteer firefighter appointed pursuant to	30
this chapter is a bona fide volunteer and not an employee for	31
purposes of section 513 of the "Patient Protection and Affordable	32
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	33
providing those fire protection services, the volunteer receives	34
any of the benefits provided in Chapter 146., 4121., or 4123. or	35
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	36
Code.	37

Sec. 737.222.  A volunteer firefighter appointed pursuant to	38
this chapter is a bona fide volunteer and not an employee for	39
purposes of section 513 of the "Patient Protection and Affordable	40
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	41
providing those fire protection services, the volunteer receives	42
any of the benefits provided in Chapter 146., 4121., or 4123. or	43
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	44
Code.	45

Sec. 1739.061. (A)(1) This section applies to both of the	46
following:	47

(a) A multiple employer welfare arrangement that issues or	48
requires the use of a standardized identification card or an	49
electronic technology for submission and routing of prescription	50
drug claims;	51

(b) A person or entity that a multiple employer welfare	52
arrangement contracts with to issue a standardized identification	53
card or an electronic technology described in division (A)(1)(a)	54
of this section.	55

(2) Notwithstanding division (A)(1) of this section, this	56
section does not apply to the issuance or required use of a	57
standardized identification card or an electronic technology for	58
the submission and routing of prescription drug claims in	59
connection with any of the following:	60

(a) Any program or arrangement covering only accident,	61
credit, dental, disability income, long-term care, hospital	62
indemnity, medicare supplement, medicare, tricare, specified	63
disease, or vision care; coverage under a	64
one-time-limited-duration policy of not longerthat is less than	65
sixtwelve months; coverage issued as a supplement to liability	66
insurance; insurance arising out of workers' compensation or	67
similar law; automobile medical payment insurance; or insurance	68
under which benefits are payable with or without regard to fault	69
and which is statutorily required to be contained in any liability	70
insurance policy or equivalent self-insurance.	71

(b) Coverage provided under the medicaid program.

72

(c) Coverage provided under an employer's self-insurance plan	73
or by any of its administrators, as defined in section 3959.01 of	74
the Revised Code, to the extent that federal law supersedes,	75
preempts, prohibits, or otherwise precludes the application of	76
this section to the plan and its administrators.	77

(B) A standardized identification card or an electronic	78
technology issued or required to be used as provided in division	79
(A)(1) of this section shall contain uniform prescription drug	80
information in accordance with either division (B)(1) or (2) of	81
this section.	82

(1) The standardized identification card or the electronic	83
technology shall be in a format and contain information fields	84
approved by the national council for prescription drug programs or	85
a successor organization, as specified in the council's or	86
successor organization's pharmacy identification card	87
implementation guide in effect on the first day of October most	88
immediately preceding the issuance or required use of the	89
standardized identification card or the electronic technology.	90

(2) If the multiple employer welfare arrangement or person	91
under contract with it to issue a standardized identification card	92
or an electronic technology requires the information for the	93
submission and routing of a claim, the standardized identification	94
card or the electronic technology shall contain any of the	95
following information:	96

(a) The name of the multiple employer welfare arrangement;

97

(b) The individual's name, group number, and identification	98
number;	99

(c) A telephone number to inquire about pharmacy-related	100
issues;	101

(d) The issuer's international identification number, labeled	102
as "ANSI BIN" or "RxBIN";	103

(e) The processor's control number, labeled as "RxPCN";

104

(f) The individual's pharmacy benefits group number if	105
different from the insured's medical group number, labeled as	106
"RxGrp."	107

(C) If the standardized identification card or the electronic	108
technology issued or required to be used as provided in division	109
(A)(1) of this section is also used for submission and routing of	110
nonpharmacy claims, the designation "Rx" is required to be	111
included as part of the labels identified in divisions (B)(2)(d)	112
and (e) of this section if the issuer's international	113
identification number or the processor's control number is	114
different for medical and pharmacy claims.	115

(D) Each multiple employer welfare arrangement described in	116
division (A) of this section shall annually file a certificate	117
with the superintendent of insurance certifying that it or any	118
person it contracts with to issue a standardized identification	119
card or electronic technology for submission and routing of	120
prescription drug claims complies with this section.	121

(E)(1) Except as provided in division (E)(2) of this section,	122
if there is a change in the information contained in the	123
standardized identification card or the electronic technology	124
issued to an individual, the multiple employer welfare arrangement	125
or person under contract with it to issue a standardized	126
identification card or an electronic technology shall issue a new	127
card or electronic technology to the individual.	128

(2) A multiple employer welfare arrangement or person under	129
contract with it is not required under division (E)(1) of this	130
section to issue a new card or electronic technology to an	131
individual more than once during a twelve-month period.	132

(F) Nothing in this section shall be construed as requiring a	133
multiple employer welfare arrangement to produce more than one	134
standardized identification card or one electronic technology for	135
use by individuals accessing health care benefits provided under a	136
multiple employer welfare arrangement.	137

Sec. 1751.14.  (A) Notwithstanding section 3901.71 of the	138
Revised Code, any policy, contract, or agreement for health care	139
services authorized by this chapter that is issued, delivered, or	140
renewed in this state and that provides that coverage of an	141
unmarried dependent child will terminate upon attainment of the	142
limiting age for dependent children specified in the policy,	143
contract, or agreement, shall also provide in substance both of	144
the following:	145

(1) Once an unmarried child has attained the limiting age for	146
dependent children, as provided in the policy, contract, or	147
agreement, upon the request of the subscriber, the health insuring	148
corporation shall offer to cover the unmarried child until the	149
child attains twenty-eighttwenty-six years of age if all of the	150
following are true:	151

(a) The child is the natural child, stepchild, or adopted	152
child of the subscriber.	153

(b) The child is a resident of this state or a full-time	154
student at an accredited public or private institution of higher	155
education.	156

(c) The child is not employed by an employer that offers any	157
health benefit plan under which the child is eligible for	158
coverage.	159

(d) The child is not eligible for coverage under the medicaid	160
program or the medicare program.	161

(2) That attainment of the limiting age for dependent	162
children shall not operate to terminate the coverage of a	163
dependent child if the child is and continues to be both of the	164
following:	165

(a) Incapable of self-sustaining employment by reason of	166
mental retardation or physical handicap;	167

(b) Primarily dependent upon the subscriber for support and	168
maintenance.	169

(B) Proof of incapacity and dependence for purposes of	170
division (A)(2) of this section shall be furnished to the health	171
insuring corporation within thirty-one days of the child's	172
attainment of the limiting age. Upon request, but not more	173
frequently than annually, the health insuring corporation may	174
require proof satisfactory to it of the continuance of such	175
incapacity and dependency.	176

(C) Nothing in this section shall do any of the following:

177

(1) Require that any policy, contract, or agreement offer	178
coverage for dependent children or provide coverage for an	179
unmarried dependent child's children as dependents on the policy,	180
contract, or agreement;	181

(2) Require an employer to pay for any part of the premium	182
for an unmarried dependent child that has attained the limiting	183
age for dependents, as provided in the policy, contract, or	184
agreement;	185

(3) Require an employer to offer health insurance coverage to	186
the dependents of any employee.	187

(D) This section does not apply to any health insuring	188
corporation policy, contract, or agreement offering only	189
supplemental health care services or specialty health care	190
services.	191

(E) As used in this section, "health benefit plan" has the	192
same meaning as in section 3924.01 of the Revised Code and also	193
includes both of the following:	194

(1) A public employee benefit plan;

195

(2) A health benefit plan as regulated under the "Employee	196
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	197

Sec. 1751.69.  (A) As used in this section, "cost sharing"	198
means the cost to an individual insured under an individual or	199
group health insuring corporation policy, contract, or agreement	200
according to any coverage limit, copayment, coinsurance,	201
deductible, or other out-of-pocket expense requirements imposed by	202
the policy, contract, or agreement.	203

(B) Notwithstanding section 3901.71 of the Revised Code and	204
subject to division (D) of this section, no individual or group	205
health insuring corporation policy, contract, or agreement	206
providing basic health care services or prescription drug services	207
that is delivered, issued for delivery, or renewed in this state,	208
if the policy, contract, or agreement provides coverage for cancer	209
chemotherapy treatment, shall fail to comply with either of the	210
following:	211

(1) The policy, contract, or agreement shall not provide	212
coverage or impose cost sharing for a prescribed, orally	213
administered cancer medication on a less favorable basis than the	214
coverage it provides or cost sharing it imposes for intraveneously	215
administered or injected cancer medications.	216

(2) The policy, contract, or agreement shall not comply with	217
division (B)(1) of this section by imposing an increase in cost	218
sharing solely for orally administered, intravenously	219
administered, or injected cancer medications.	220

(C) Notwithstanding any provision of this section to the	221
contrary, an individual or group health insuring corporation	222
policy, contract, or agreement shall be deemed to be in compliance	223
with this section if the cost sharing imposed under such a policy,	224
contract, or agreement for orally administered cancer treatments	225
does not exceed one hundred dollars per prescription fill. The	226
cost sharing limit of one hundred dollars per prescription fill	227
shall apply to a high deductible plan, as defined in 26 U.S.C.	228
223, or a catastrophic plan, as defined in 42 U.S.C. 18022, only	229
after the deductible has been met.	230

(D) The prohibitions in division (B) of this section do not	231
preclude an individual or group health insuring corporation	232
policy, contract, or agreement from requiring an enrollee to	233
obtain prior authorization before orally administered cancer	234
medication is dispensed to the enrollee.	235

(E) A health insuring corporation that offers coverage for	236
basic health care services is not required to comply with division	237
(B) of this section if all of the following apply:	238

(1) The health insuring corporation submits documentation	239
certified by an independent member of the American academy of	240
actuaries to the superintendent of insurance showing that	241
compliance with division (B)(1) of this section for a period of at	242
least six months independently caused the health insuring	243
corporation's costs for claims and administrative expenses for the	244
coverage of basic health care services to increase by more than	245
one per cent per year.	246

(2) The health insuring corporation submits a signed letter	247
from an independent member of the American academy of actuaries to	248
the superintendent of insurance opining that the increase in costs	249
described in division (E)(1) of this section could reasonably	250
justify an increase of more than one per cent in the annual	251
premiums or rates charged by the health insuring corporation for	252
the coverage of basic health care services.	253

(3)(a) The superintendent of insurance makes the following	254
determinations from the documentation and opinion submitted	255
pursuant to divisions (E)(1) and (2) of this section:	256

(i) Compliance with division (B)(1) of this section for a	257
period of at least six months independently caused the health	258
insuring corporation's costs for claims and administrative	259
expenses for the coverage of basic health care services to	260
increase more than one per cent per year.	261

(ii) The increase in costs reasonably justifies an increase	262
of more than one per cent in the annual premiums or rates charged	263
by the health insuring corporation for the coverage of basic	264
health care services.	265

(b) Any determination made by the superintendent under	266
division (E)(3) of this section is subject to Chapter 119. of the	267
Revised Code.	268

Sec. 3923.022.  (A) As used in this section:

269

(1)(a) "Administrative expense" means the amount resulting	270
from the following: the amount of premiums earned by the insurer	271
for sickness and accident insurance business plus the amount of	272
losses recovered from reinsurance coverage minus the sum of the	273
amount of claims for losses paid; the amount of losses incurred	274
but not reported; the amount incurred for state fees, federal and	275
state taxes, and reinsurance; and the incurred costs and expenses	276
related, either directly or indirectly, to the payment of	277
commissions, measures to control fraud, and managed care.	278

(b) "Administrative expense" does not include any amounts	279
collected, or administrative expenses incurred, by an insurer for	280
the administration of an employee health benefit plan subject to	281
regulation by the federal "Employee Retirement Income Security Act	282
of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended. "Amounts	283
collected or administrative expenses incurred" means the total	284
amount paid to an administrator for the administration and payment	285
of claims minus the sum of the amount of claims for losses paid	286
and the amount of losses incurred but not reported.	287

(2) "Insurer" means any insurance company authorized under	288
Title XXXIX of the Revised Code to do the business of sickness and	289
accident insurance in this state.	290

(3) "Sickness and accident insurance business" does not	291
include coverage provided by an insurer for specific diseases or	292
accidents only; any hospital indemnity, medicare supplement,	293
long-term care, disability income, one-time-limited-duration	294
policy of no longerthat is less than sixtwelve months, or other	295
policy that offers only supplemental benefits; or coverage	296
provided to individuals who are not residents of this state.	297

(4) "Individual business" includes both individual sickness	298
and accident insurance and sickness and accident insurance made	299
available by insurers in the individual market to individuals,	300
with or without family members or dependents, through group	301
policies issued to one or more associations or entities.	302

(B) Notwithstanding section 3941.14 of the Revised Code, each	303
insurer shall have aggregate administrative expenses of no more	304
than twenty per cent of the premium income of the insurer, based	305
on the premiums earned in that year on the sickness and accident	306
insurance business of the insurer.	307

(C)(1) Each insurer, on the first day of January or within	308
sixty days thereafter, shall annually prepare, under oath, and	309
deposit in the office of the superintendent of insurance a	310
statement of the aggregate administrative expenses of the insurer,	311
based on the premiums earned in the immediately preceding calendar	312
year on the sickness and accident insurance business of the	313
insurer. The statement shall itemize and separately detail all of	314
the following information with respect to the insurer's sickness	315
and accident insurance business:	316

(a) The amount of premiums earned by the insurer both before	317
and after any costs related to the insurer's purchase of	318
reinsurance coverage;	319

(b) The total amount of claims for losses paid by the insurer	320
both before and after any reimbursement from reinsurance coverage;	321

(c) The amount of any losses incurred by the insurer but not	322
reported by the insurer in the current or prior year;	323

(d) The amount of costs incurred by the insurer for state	324
fees and federal and state taxes;	325

(e) The amount of costs incurred by the insurer for	326
reinsurance coverage;	327

(f) The amount of costs incurred by the insurer that are	328
related to the insurer's payment of commissions;	329

(g) The amount of costs incurred by the insurer that are	330
related to the insurer's fraud prevention measures;	331

(h) The amount of costs incurred by the insurer that are	332
related to managed care; and	333

(i) Any other administrative expenses incurred by the	334
insurer.	335

(2) The statement also shall include all of the information	336
required under division (C)(1) of this section separately detailed	337
for the insurer's individual business, small group business, and	338
large group business.	339

(D) No insurer shall fail to comply with this section.

340

(E) If the superintendent determines that an insurer has	341
violated this section, the superintendent, pursuant to an	342
adjudication conducted in accordance with Chapter 119. of the	343
Revised Code, may order the suspension of the insurer's license to	344
do the business of sickness and accident insurance in this state	345
until the superintendent is satisfied that the insurer is in	346
compliance with this section. If the insurer continues to do the	347
business of sickness and accident insurance in this state while	348
under the suspension order, the superintendent shall order the	349
insurer to pay one thousand dollars for each day of the violation.	350

(F) Any money collected by the superintendent under division	351
(E) of this section shall be deposited by the superintendent into	352
the state treasury to the credit of the department of insurance	353
operating fund.	354

(G) The statement of aggregate expenses filed pursuant to	355
this section separately detailing an insurer's individual, small	356
group, and large group business shall be considered work papers	357
resulting from the conduct of a market analysis of an entity	358
subject to examination by the superintendent under division (C) of	359
section 3901.48 of the Revised Code, except that the	360
superintendent may share aggregated market information that	361
identifies the premiums earned as reported under division	362
(C)(1)(a) of this section, the administrative expenses reported	363
under division (C)(1)(i) of this section, the amount of	364
commissions reported under division (C)(1)(f) of this section, the	365
amount of taxes paid as reported under division (C)(1)(d) of this	366
section, the total of the remaining benefit costs as reported	367
under divisions (C)(1)(b) and (c) of this section, and the amount	368
of fraud and managed care expenses reported under divisions	369
(C)(1)(g) and (h) of this section.	370

Sec. 3923.24.  (A) Notwithstanding section 3901.71 of the	371
Revised Code, every certificate furnished by an insurer in	372
connection with, or pursuant to any provision of, any group	373
sickness and accident insurance policy delivered, issued for	374
delivery, renewed, or used in this state on or after January 1,	375
1972, every policy of sickness and accident insurance delivered,	376
issued for delivery, renewed, or used in this state on or after	377
January 1, 1972, and every multiple employer welfare arrangement	378
offering an insurance program, which provides that coverage of an	379
unmarried dependent child of a parent or legal guardian will	380
terminate upon attainment of the limiting age for dependent	381
children specified in the contract shall also provide in substance	382
both of the following:	383

(1) Once an unmarried child has attained the limiting age for	384
dependent children, as provided in the policy, upon the request of	385
the insured, the insurer shall offer to cover the unmarried child	386
until the child attains twenty-eighttwenty-six years of age if	387
all of the following are true:	388

(a) The child is the natural child, stepchild, or adopted	389
child of the insured.	390

(b) The child is a resident of this state or a full-time	391
student at an accredited public or private institution of higher	392
education.	393

(c) The child is not employed by an employer that offers any	394
health benefit plan under which the child is eligible for	395
coverage.	396

(d) The child is not eligible for the medicaid program or the	397
medicare program.	398

(2) That attainment of the limiting age for dependent	399
children shall not operate to terminate the coverage of a	400
dependent child if the child is and continues to be both of the	401
following:	402

(a) Incapable of self-sustaining employment by reason of	403
mental retardation or physical handicap;	404

(b) Primarily dependent upon the policyholder or certificate	405
holder for support and maintenance.	406

(B) Proof of such incapacity and dependence for purposes of	407
division (A)(2) of this section shall be furnished by the	408
policyholder or by the certificate holder to the insurer within	409
thirty-one days of the child's attainment of the limiting age.	410
Upon request, but not more frequently than annually after the	411
two-year period following the child's attainment of the limiting	412
age, the insurer may require proof satisfactory to it of the	413
continuance of such incapacity and dependency.	414

(C) Nothing in this section shall require an insurer to cover	415
a dependent child who is mentally retarded or physically	416
handicapped if the contract is underwritten on evidence of	417
insurability based on health factors set forth in the application,	418
or if such dependent child does not satisfy the conditions of the	419
contract as to any requirement for evidence of insurability or	420
other provision of the contract, satisfaction of which is required	421
for coverage thereunder to take effect. In any such case, the	422
terms of the contract shall apply with regard to the coverage or	423
exclusion of the dependent from such coverage. Nothing in this	424
section shall apply to accidental death or dismemberment benefits	425
provided by any such policy of sickness and accident insurance.	426

(D) Nothing in this section shall do any of the following:

427

(1) Require that any policy offer coverage for dependent	428
children or provide coverage for an unmarried dependent child's	429
children as dependents on the policy;	430

(2) Require an employer to pay for any part of the premium	431
for an unmarried dependent child that has attained the limiting	432
age for dependents, as provided in the policy;	433

(3) Require an employer to offer health insurance coverage to	434
the dependents of any employee.	435

(E) This section does not apply to any policies or	436
certificates covering only accident, credit, dental, disability	437
income, long-term care, hospital indemnity, medicare supplement,	438
specified disease, or vision care; coverage under a	439
one-time-limited-duration policy of not longerthat is less than	440
sixtwelve months; coverage issued as a supplement to liability	441
insurance; insurance arising out of a workers' compensation or	442
similar law; automobile medical-payment insurance; or insurance	443
under which benefits are payable with or without regard to fault	444
and that is statutorily required to be contained in any liability	445
insurance policy or equivalent self-insurance.	446

(F) As used in this section, "health benefit plan" has the	447
same meaning as in section 3924.01 of the Revised Code and also	448
includes both of the following:	449

(1) A public employee benefit plan;

450

(2) A health benefit plan as regulated under the "Employee	451
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	452

Sec. 3923.241. (A) Notwithstanding section 3901.71 of the	453
Revised Code, any public employee benefit plan that provides that	454
coverage of an unmarried dependent child will terminate upon	455
attainment of the limiting age for dependent children specified in	456
the plan shall also provide in substance both of the following:	457

(1) Once an unmarried child has attained the limiting age for	458
dependent children, as provided in the plan, upon the request of	459
the employee, the public employee benefit plan shall offer to	460
cover the unmarried child until the child attains twenty-eight	461
twenty-six years of age if all of the following are true:	462

(a) The child is the natural child, stepchild, or adopted	463
child of the employee.	464

(b) The child is a resident of this state or a full-time	465
student at an accredited public or private institution of higher	466
education.	467

(c) The child is not employed by an employer that offers any	468
health benefit plan under which the child is eligible for	469
coverage.	470

(d) The child is not eligible for the medicaid program or the	471
medicare program.	472

(2) That attainment of the limiting age for dependent	473
children shall not operate to terminate the coverage of a	474
dependent child if the child is and continues to be both of the	475
following:	476

(a) Incapable of self-sustaining employment by reason of	477
mental retardation or physical handicap;	478

(b) Primarily dependent upon the plan member for support and	479
maintenance.	480

(B) Proof of incapacity and dependence for purposes of	481
division (A)(2) of this section shall be furnished to the public	482
employee benefit plan within thirty-one days of the child's	483
attainment of the limiting age. Upon request, but not more	484
frequently than annually, the public employee benefit plan may	485
require proof satisfactory to it of the continuance of such	486
incapacity and dependency.	487

(C) Nothing in this section shall do any of the following:

488

(1) Require that any public employee benefit plan offer	489
coverage for dependent children or provide coverage for an	490
unmarried dependent child's children as dependents on the public	491
employee benefit plan;	492

(2) Require an employer to pay for any part of the premium	493
for an unmarried dependent child that has attained the limiting	494
age for dependents, as provided in the plan;	495

(3) Require an employer to offer health insurance coverage to	496
the dependents of any employee.	497

(D) This section does not apply to any public employee	498
benefit plan covering only accident, credit, dental, disability	499
income, long-term care, hospital indemnity, medicare supplement,	500
specified disease, or vision care; coverage under a	501
one-time-limited-duration policy of not longerthat is less than	502
sixtwelve months; coverage issued as a supplement to liability	503
insurance; insurance arising out of a workers' compensation or	504
similar law; automobile medical-payment insurance; or insurance	505
under which benefits are payable with or without regard to fault	506
and which is statutorily required to be contained in any liability	507
insurance policy or equivalent self-insurance.	508

(E) As used in this section, "health benefit plan" has the	509
same meaning as in section 3924.01 of the Revised Code and also	510
includes both of the following:	511

(1) A public employee benefit plan;

512

(2) A health benefit plan as regulated under the "Employee	513
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	514

Sec. 3923.281.  (A) As used in this section:

515

(1) "Biologically based mental illness" means schizophrenia,	516
schizoaffective disorder, major depressive disorder, bipolar	517
disorder, paranoia and other psychotic disorders,	518
obsessive-compulsive disorder, and panic disorder, as these terms	519
are defined in the most recent edition of the diagnostic and	520
statistical manual of mental disorders published by the American	521
psychiatric association.	522

(2) "Policy of sickness and accident insurance" has the same	523
meaning as in section 3923.01 of the Revised Code, but excludes	524
any hospital indemnity, medicare supplement, long-term care,	525
disability income, one-time-limited-duration policy of not longer	526
that is less than sixtwelve months, supplemental benefit, or	527
other policy that provides coverage for specific diseases or	528
accidents only; any policy that provides coverage for workers'	529
compensation claims compensable pursuant to Chapters 4121. and	530
4123. of the Revised Code; and any policy that provides coverage	531
to medicaid recipients.	532

(B) Notwithstanding section 3901.71 of the Revised Code, and	533
subject to division (E) of this section, every policy of sickness	534
and accident insurance shall provide benefits for the diagnosis	535
and treatment of biologically based mental illnesses on the same	536
terms and conditions as, and shall provide benefits no less	537
extensive than, those provided under the policy of sickness and	538
accident insurance for the treatment and diagnosis of all other	539
physical diseases and disorders, if both of the following apply:	540

(1) The biologically based mental illness is clinically	541
diagnosed by a physician authorized under Chapter 4731. of the	542
Revised Code to practice medicine and surgery or osteopathic	543
medicine and surgery; a psychologist licensed under Chapter 4732.	544
of the Revised Code; a licensed professional clinical counselor,	545
licensed professional counselor, independent social worker, or	546
independent marriage and family therapist licensed under Chapter	547
4757. of the Revised Code; or a clinical nurse specialist or	548
certified nurse practitioner licensed under Chapter 4723. of the	549
Revised Code whose nursing specialty is mental health.	550

(2) The prescribed treatment is not experimental or	551
investigational, having proven its clinical effectiveness in	552
accordance with generally accepted medical standards.	553

(C) Division (B) of this section applies to all coverages and	554
terms and conditions of the policy of sickness and accident	555
insurance, including, but not limited to, coverage of inpatient	556
hospital services, outpatient services, and medication; maximum	557
lifetime benefits; copayments; and individual and family	558
deductibles.	559

(D) Nothing in this section shall be construed as prohibiting	560
a sickness and accident insurance company from taking any of the	561
following actions:	562

(1) Negotiating separately with mental health care providers	563
with regard to reimbursement rates and the delivery of health care	564
services;	565

(2) Offering policies that provide benefits solely for the	566
diagnosis and treatment of biologically based mental illnesses;	567

(3) Managing the provision of benefits for the diagnosis or	568
treatment of biologically based mental illnesses through the use	569
of pre-admission screening, by requiring beneficiaries to obtain	570
authorization prior to treatment, or through the use of any other	571
mechanism designed to limit coverage to that treatment determined	572
to be necessary;	573

(4) Enforcing the terms and conditions of a policy of	574
sickness and accident insurance.	575

(E) An insurer that offers any policy of sickness and	576
accident insurance is not required to provide benefits for the	577
diagnosis and treatment of biologically based mental illnesses	578
pursuant to division (B) of this section if all of the following	579
apply:	580

(1) The insurer submits documentation certified by an	581
independent member of the American academy of actuaries to the	582
superintendent of insurance showing that incurred claims for	583
diagnostic and treatment services for biologically based mental	584
illnesses for a period of at least six months independently caused	585
the insurer's costs for claims and administrative expenses for the	586
coverage of all other physical diseases and disorders to increase	587
by more than one per cent per year.	588

(2) The insurer submits a signed letter from an independent	589
member of the American academy of actuaries to the superintendent	590
of insurance opining that the increase described in division	591
(E)(1) of this section could reasonably justify an increase of	592
more than one per cent in the annual premiums or rates charged by	593
the insurer for the coverage of all other physical diseases and	594
disorders.	595

(3) The superintendent of insurance makes the following	596
determinations from the documentation and opinion submitted	597
pursuant to divisions (E)(1) and (2) of this section:	598

(a) Incurred claims for diagnostic and treatment services for	599
biologically based mental illnesses for a period of at least six	600
months independently caused the insurer's costs for claims and	601
administrative expenses for the coverage of all other physical	602
diseases and disorders to increase by more than one per cent per	603
year.	604

(b) The increase in costs reasonably justifies an increase of	605
more than one per cent in the annual premiums or rates charged by	606
the insurer for the coverage of all other physical diseases and	607
disorders.	608

Any determination made by the superintendent under this	609
division is subject to Chapter 119. of the Revised Code.	610

Sec. 3923.57.  Notwithstanding any provision of this chapter,	611
every individual policy of sickness and accident insurance that is	612
delivered, issued for delivery, or renewed in this state is	613
subject to the following conditions, as applicable:	614

(A) Pre-existing conditions provisions shall not exclude or	615
limit coverage for a period beyond twelve months following the	616
policyholder's effective date of coverage and may only relate to	617
conditions during the six months immediately preceding the	618
effective date of coverage.	619

(B) In determining whether a pre-existing conditions	620
provision applies to a policyholder or dependent, each policy	621
shall credit the time the policyholder or dependent was covered	622
under a previous policy, contract, or plan if the previous	623
coverage was continuous to a date not more than thirty days prior	624
to the effective date of the new coverage, exclusive of any	625
applicable service waiting period under the policy.	626

(C)(1) Except as otherwise provided in division (C) of this	627
section, an insurer that provides an individual sickness and	628
accident insurance policy to an individual shall renew or continue	629
in force such coverage at the option of the individual.	630

(2) An insurer may nonrenew or discontinue coverage of an	631
individual in the individual market based only on one or more of	632
the following reasons:	633

(a) The individual failed to pay premiums or contributions in	634
accordance with the terms of the policy or the insurer has not	635
received timely premium payments.	636

(b) The individual performed an act or practice that	637
constitutes fraud or made an intentional misrepresentation of	638
material fact under the terms of the policy.	639

(c) The insurer is ceasing to offer coverage in the	640
individual market in accordance with division (D) of this section	641
and the applicable laws of this state.	642

(d) If the insurer offers coverage in the market through a	643
network plan, the individual no longer resides, lives, or works in	644
the service area, or in an area for which the insurer is	645
authorized to do business; provided, however, that such coverage	646
is terminated uniformly without regard to any health	647
status-related factor of covered individuals.	648

(e) If the coverage is made available in the individual	649
market only through one or more bona fide associations, the	650
membership of the individual in the association, on the basis of	651
which the coverage is provided, ceases; provided, however, that	652
such coverage is terminated under division (C)(2)(e) of this	653
section uniformly without regard to any health status-related	654
factor of covered individuals.	655

An insurer offering coverage to individuals solely through	656
membership in a bona fide association shall not be deemed, by	657
virtue of that offering, to be in the individual market for	658
purposes of sections 3923.58 and 3923.581 of the Revised Code.	659
Such an insurer shall not be required to accept applicants for	660
coverage in the individual market pursuant to sections 3923.58 and	661
3923.581 of the Revised Code unless the insurer also offers	662
coverage to individuals other than through bona fide associations.	663

(3) An insurer may cancel or decide not to renew the coverage	664
of a dependent of an individual if the dependent has performed an	665
act or practice that constitutes fraud or made an intentional	666
misrepresentation of material fact under the terms of the coverage	667
and if the cancellation or nonrenewal is not based, either	668
directly or indirectly, on any health status-related factor in	669
relation to the dependent.	670

(D)(1) If an insurer decides to discontinue offering a	671
particular type of health insurance coverage offered in the	672
individual market, coverage of such type may be discontinued by	673
the insurer if the insurer does all of the following:	674

(a) Provides notice to each individual provided coverage of	675
this type in such market of the discontinuation at least ninety	676
days prior to the date of the discontinuation of the coverage;	677

(b) Offers to each individual provided coverage of this type	678
in such market, the option to purchase any other individual health	679
insurance coverage currently being offered by the insurer for	680
individuals in that market;	681

(c) In exercising the option to discontinue coverage of this	682
type and in offering the option of coverage under division	683
(D)(1)(b) of this section, acts uniformly without regard to any	684
health status-related factor of covered individuals or of	685
individuals who may become eligible for such coverage.	686

(2) If an insurer elects to discontinue offering all health	687
insurance coverage in the individual market in this state, health	688
insurance coverage may be discontinued by the insurer only if both	689
of the following apply:	690

(a) The insurer provides notice to the department of	691
insurance and to each individual of the discontinuation at least	692
one hundred eighty days prior to the date of the expiration of the	693
coverage.	694

(b) All health insurance delivered or issued for delivery in	695
this state in such market is discontinued and coverage under that	696
health insurance in that market is not renewed.	697

(3) In the event of a discontinuation under division (D)(2)	698
of this section in the individual market, the insurer shall not	699
provide for the issuance of any health insurance coverage in the	700
market and this state during the five-year period beginning on the	701
date of the discontinuation of the last health insurance coverage	702
not so renewed.	703

(E) Notwithstanding divisions (C) and (D) of this section, an	704
insurer may, at the time of coverage renewal, modify the health	705
insurance coverage for a policy form offered to individuals in the	706
individual market if the modification is consistent with the law	707
of this state and effective on a uniform basis among all	708
individuals with that policy form.	709

(F) Such policies are subject to sections 2743 and 2747 of	710
the "Health Insurance Portability and Accountability Act of 1996,"	711
Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg-43 and	712
300gg-47, as amended.	713

(G) Sections 3924.031 and 3924.032 of the Revised Code shall	714
apply to sickness and accident insurance policies offered in the	715
individual market in the same manner as they apply to health	716
benefit plans offered in the small employer market.	717

In accordance with 45 C.F.R. 148.102, divisions (C) to (G) of	718
this section also apply to all group sickness and accident	719
insurance policies that are not sold in connection with an	720
employment-related group health plan and that provide more than	721
short-term, limited duration coverage.	722

In applying divisions (C) to (G) of this section with respect	723
to health insurance coverage that is made available by an insurer	724
in the individual market to individuals only through one or more	725
associations, the term "individual" includes the association of	726
which the individual is a member.	727

For purposes of this section, any policy issued pursuant to	728
division (C) of section 3923.13 of the Revised Code in connection	729
with a public or private college or university student health	730
insurance program is considered to be issued to a bona fide	731
association.	732

As used in this section, "bona fide association" has the same	733
meaning as in section 3924.03 of the Revised Code, and "health	734
status-related factor" and "network plan" have the same meanings	735
as in section 3924.031 of the Revised Code.	736

This section does not apply to any policy that provides	737
coverage for specific diseases or accidents only, or to any	738
hospital indemnity, medicare supplement, long-term care,	739
disability income, one-time-limited-duration policy of no longer	740
that is less than sixtwelve months, or other policy that offers	741
only supplemental benefits.	742

Sec. 3923.58.  (A) As used in sections 3923.58 and 3923.59 of	743
the Revised Code:	744

(1) "Base rate" means, as to any health benefit plan that is	745
issued by a carrier in the individual market, the lowest premium	746
rate for new or existing business prescribed by the carrier for	747
the same or similar coverage under a plan or arrangement covering	748
any individual with similar case characteristics.	749

(2) "Carrier," "health benefit plan," and "MEWA" have the	750
same meanings as in section 3924.01 of the Revised Code.	751

(3) "Network plan" means a health benefit plan of a carrier	752
under which the financing and delivery of medical care, including	753
items and services paid for as medical care, are provided, in	754
whole or in part, through a defined set of providers under	755
contract with the carrier.	756

(4) "Ohio health care basic and standard plans" means those	757
plans established under section 3924.10 of the Revised Code.	758

(5) "Pre-existing conditions provision" means a policy	759
provision that excludes or limits coverage for charges or expenses	760
incurred during a specified period following the insured's	761
effective date of coverage as to a condition which, during a	762
specified period immediately preceding the effective date of	763
coverage, had manifested itself in such a manner as would cause an	764
ordinarily prudent person to seek medical advice, diagnosis, care,	765
or treatment or for which medical advice, diagnosis, care, or	766
treatment was recommended or received, or a pregnancy existing on	767
the effective date of coverage.	768

(B) Beginning in January of each year, carriers in the	769
business of issuing health benefit plans to individuals and	770
nonemployer groups, except individual health benefit plans issued	771
pursuant to sections 1751.16 and 3923.122 of the Revised Code,	772
shall accept applicants for open enrollment coverage, as set forth	773
in this division, in the order in which they apply for coverage	774
and subject to the limitation set forth in division (G) of this	775
section. Carriers shall accept for coverage pursuant to this	776
section individuals to whom both of the following conditions	777
apply:	778

(1) The individual is not applying for coverage as an	779
employee of an employer, as a member of an association, or as a	780
member of any other group.	781

(2) The individual is not covered, and is not eligible for	782
coverage, under any other private or public health benefits	783
arrangement, including the medicare program established under	784
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42	785
U.S.C.A. 301, as amended, or any other act of congress or law of	786
this or any other state of the United States that provides	787
benefits comparable to the benefits provided under this section,	788
any medicare supplement policy, or any continuation of coverage	789
policy under state or federal law.	790

(C) A carrier shall offer to any individual accepted under	791
this section the Ohio health care basic and standard plans or	792
health benefit plans that are substantially similar to the Ohio	793
health care basic and standard plans in benefit plan design and	794
scope of covered services.	795

A carrier may offer other health benefit plans in addition	796
to, but not in lieu of, the plans required to be offered under	797
this division. A basic health benefit plan shall provide, at a	798
minimum, the coverage provided by the Ohio health care basic plan	799
or any health benefit plan that is substantially similar to the	800
Ohio health care basic plan in benefit plan design and scope of	801
covered services. A standard health benefit plan shall provide, at	802
a minimum, the coverage provided by the Ohio health care standard	803
plan or any health benefit plan that is substantially similar to	804
the Ohio health care standard plan in benefit plan design and	805
scope of covered services.	806

For purposes of this division, the superintendent of	807
insurance shall determine whether a health benefit plan is	808
substantially similar to the Ohio health care basic and standard	809
plans in benefit plan design and scope of covered services.	810

(D)(1) Health benefit plans issued under this section may	811
establish pre-existing conditions provisions that exclude or limit	812
coverage for a period of up to twelve months following the	813
individual's effective date of coverage and that may relate only	814
to conditions during the six months immediately preceding the	815
effective date of coverage. A health insuring corporation may	816
apply a pre-existing condition provision for any basic health care	817
service related to a transplant of a body organ if the transplant	818
occurs within one year after the effective date of an enrollee's	819
coverage under this section except with respect to a newly born	820
child who meets the requirements for coverage under section	821
1751.61 of the Revised Code.	822

(2) In determining whether a pre-existing conditions	823
provision applies to an insured or dependent, each policy shall	824
credit the time the insured or dependent was covered under a	825
previous policy, contract, or plan if the previous coverage was	826
continuous to a date not more than sixty-three days prior to the	827
effective date of the new coverage, exclusive of any applicable	828
service waiting period under the policy.	829

(E) Premiums charged to individuals under this section may	830
not exceed the amounts specified below:	831

(1) For calendar years 2010 and 2011, an amount that is two	832
times the base rate for coverage offered to any other individual	833
to which the carrier is currently accepting new business, and for	834
which similar copayments and deductibles are applied;	835

(2) For calendar year 2012 and every year thereafter, an	836
amount that is one and one-half times the base rate for coverage	837
offered to any other individual to which the carrier is currently	838
accepting new business and for which similar copayments and	839
deductibles are applied, unless the superintendent of insurance	840
determines that the amendments by this act to this section and	841
section 3923.581 of the Revised Code, have resulted in the	842
market-wide average medical loss ratio for coverage sold to	843
individual insureds and nonemployer group insureds in this state,	844
including open enrollment insureds, to increase by more than five	845
and one quarter percentage points during calendar year 2010. If	846
the superintendent makes that determination, the premium limit	847
established by division (E)(1) of this section shall remain in	848
effect. The superintendent's determination shall be supported by a	849
signed letter from a member of the American academy of actuaries.	850

(F) In offering health benefit plans under this section, a	851
carrier may require the purchase of health benefit plans that	852
condition the reimbursement of health services upon the use of a	853
specific network of providers.	854

(G)(1) A carrier shall not be required to accept new	855
applicants under this section if the total number of the carrier's	856
current insureds with open enrollment coverage issued under this	857
section calculated as of the immediately preceding thirty-first	858
day of December and excluding the carrier's medicare supplement	859
policies and conversion or continuation of coverage policies under	860
state or federal law and any policies described in division (L) of	861
this section meets the following limits:	862

(a) For calendar years 2010 and 2011, four per cent of the	863
carrier's total number of individual or nonemployer group insureds	864
in this state;	865

(b) For calendar year 2012 and every year thereafter, eight	866
per cent of the carrier's total number of insured individuals and	867
nonemployer group insureds in this state, unless the	868
superintendent of insurance determines that the amendments by this	869
act to this section and section 3923.581 of the Revised Code, have	870
resulted in the market-wide average medical loss ratio for	871
coverage sold to individual insureds and nonemployer group	872
insureds in this state, including open enrollment insureds, to	873
increase by more than five and one quarter percentage points	874
during calendar year 2010. If the superintendent makes that	875
determination, the enrollment limit established by division	876
(G)(1)(a) of this section shall remain in effect. The	877
superintendent's determination shall be supported by a signed	878
letter from a member of the American academy of actuaries.	879

(2) An officer of the carrier shall certify to the department	880
of insurance when it has met the enrollment limit set forth in	881
division (G)(1) of this section. Upon providing such	882
certification, the carrier shall be relieved of its open	883
enrollment requirement under this section as long as the carrier	884
continues to meet the open enrollment limit. If the total number	885
of the carrier's current insureds with open enrollment coverage	886
issued under this section falls below the enrollment limit, the	887
carrier shall accept new applicants. A carrier may establish a	888
waiting list if the carrier has met the open enrollment limit and	889
shall notify the superintendent if the carrier has a waiting list	890
in effect.	891

(H) A carrier shall not be required to accept under this	892
section applicants who, at the time of enrollment, are confined to	893
a health care facility because of chronic illness, permanent	894
injury, or other infirmity that would cause economic impairment to	895
the carrier if the applicants were accepted. A carrier shall not	896
be required to make the effective date of benefits for individuals	897
accepted under this section earlier than ninety days after the	898
date of acceptance, except that when the individual had prior	899
coverage with a health benefit plan that was terminated by a	900
carrier because the carrier exited the market and the individual	901
was accepted for open enrollment under this section within	902
sixty-three days of that termination, the effective date of	903
benefits shall be the date of enrollment.	904

(I) The requirements of this section do not apply to any	905
carrier that is currently in a state of supervision, insolvency,	906
or liquidation. If a carrier demonstrates to the satisfaction of	907
the superintendent that the requirements of this section would	908
place the carrier in a state of supervision, insolvency, or	909
liquidation, or would otherwise jeopardize the carrier's economic	910
viability overall or in the individual market, the superintendent	911
may waive or modify the requirements of division (B) or (G) of	912
this section. The actions of the superintendent under this	913
division shall be effective for a period of not more than one	914
year. At the expiration of such time, a new showing of need for a	915
waiver or modification by the carrier shall be made before a new	916
waiver or modification is issued or imposed.	917

(J) No hospital, health care facility, or health care	918
practitioner, and no person who employs any health care	919
practitioner, shall balance bill any individual or dependent of an	920
individual for any health care supplies or services provided to	921
the individual or dependent who is insured under a policy issued	922
under this section. The hospital, health care facility, or health	923
care practitioner, or any person that employs the health care	924
practitioner, shall accept payments made to it by the carrier	925
under the terms of the policy or contract insuring or covering	926
such individual as payment in full for such health care supplies	927
or services.	928

As used in this division, "hospital" has the same meaning as	929
in section 3727.01 of the Revised Code; "health care practitioner"	930
has the same meaning as in section 4769.01 of the Revised Code;	931
and "balance bill" means charging or collecting an amount in	932
excess of the amount reimbursable or payable under the policy or	933
health care service contract issued to an individual under this	934
section for such health care supply or service. "Balance bill"	935
does not include charging for or collecting copayments or	936
deductibles required by the policy or contract.	937

(K) A carrier may pay an agent a commission in the amount of	938
not more than five per cent of the premium charged for initial	939
placement or for otherwise securing the issuance of a policy or	940
contract issued to an individual under this section, and not more	941
than four per cent of the premium charged for the renewal of such	942
a policy or contract. The superintendent may adopt, in accordance	943
with Chapter 119. of the Revised Code, such rules as are necessary	944
to enforce this division.	945

(L) This section does not apply to any policy that provides	946
coverage for specific diseases or accidents only, or to any	947
hospital indemnity, medicare supplement, long-term care,	948
disability income, one-time-limited-duration policy of no longer	949
that is less than sixtwelve months, or other policy that offers	950
only supplemental benefits.	951

(M) If a carrier offers a health benefit plan in the	952
individual market through a network plan, the carrier may do both	953
of the following:	954

(1) Limit the individuals that may apply for such coverage to	955
those who live, work, or reside in the service area of the network	956
plan;	957

(2) Within the service area of the network plan, deny the	958
coverage to individuals if the carrier has demonstrated both of	959
the following to the superintendent:	960

(a) The carrier will not have the capacity to deliver	961
services adequately to any additional individuals because of the	962
carrier's obligations to existing group contract holders and	963
individuals.	964

(b) The carrier is applying division (M)(2) of this section	965
uniformly to all individuals without regard to any health	966
status-related factors of those individuals.	967

(N) A carrier that, pursuant to division (M)(2) of this	968
section, denies coverage to an individual in the service area of a	969
network plan, shall not offer coverage in the individual market	970
within that service area for at least one hundred eighty days	971
after the date the carrier denies the coverage.	972

Sec. 3923.601. (A)(1) This section applies to both of the	973
following:	974

(a) A sickness and accident insurer that issues or requires	975
the use of a standardized identification card or an electronic	976
technology for submission and routing of prescription drug claims	977
pursuant to a policy, contract, or agreement for health care	978
services;	979

(b) A person that a sickness and accident insurer contracts	980
with to issue a standardized identification card or an electronic	981
technology described in division (A)(1)(a) of this section.	982

(2) Notwithstanding division (A)(1) of this section, this	983
section does not apply to the issuance or required use of a	984
standardized identification card or an electronic technology for	985
the submission and routing of prescription drug claims in	986
connection with any of the following:	987

(a) Any individual or group policy of sickness and accident	988
insurance covering only accident, credit, dental, disability	989
income, long-term care, hospital indemnity, medicare supplement,	990
medicare, tricare, specified disease, or vision care; coverage	991
under a one-time-limited-duration policy of not longerthat is	992
less than sixtwelve months; coverage issued as a supplement to	993
liability insurance; insurance arising out of workers'	994
compensation or similar law; automobile medical payment insurance;	995
or insurance under which benefits are payable with or without	996
regard to fault and which is statutorily required to be contained	997
in any liability insurance policy or equivalent self-insurance.	998

(b) Coverage provided under the medicaid program.

999

(c) Coverage provided under an employer's self-insurance plan	1000
or by any of its administrators, as defined in section 3959.01 of	1001
the Revised Code, to the extent that federal law supersedes,	1002
preempts, prohibits, or otherwise precludes the application of	1003
this section to the plan and its administrators.	1004

(B) A standardized identification card or an electronic	1005
technology issued or required to be used as provided in division	1006
(A)(1) of this section shall contain uniform prescription drug	1007
information in accordance with either division (B)(1) or (2) of	1008
this section.	1009

(1) The standardized identification card or the electronic	1010
technology shall be in a format and contain information fields	1011
approved by the national council for prescription drug programs or	1012
a successor organization, as specified in the council's or	1013
successor organization's pharmacy identification card	1014
implementation guide in effect on the first day of October most	1015
immediately preceding the issuance or required use of the	1016
standardized identification card or the electronic technology.	1017

(2) If the insurer or person under contract with the insurer	1018
to issue a standardized identification card or an electronic	1019
technology requires the information for the submission and routing	1020
of a claim, the standardized identification card or the electronic	1021
technology shall contain any of the following information:	1022

(a) The insurer's name;

1023

(b) The insured's name, group number, and identification	1024
number;	1025

(c) A telephone number to inquire about pharmacy-related	1026
issues;	1027

(d) The issuer's international identification number, labeled	1028
as "ANSI BIN" or "RxBIN";	1029

(e) The processor's control number, labeled as "RxPCN";

1030

(f) The insured's pharmacy benefits group number if different	1031
from the insured's medical group number, labeled as "RxGrp."	1032

(C) If the standardized identification card or the electronic	1033
technology issued or required to be used as provided in division	1034
(A)(1) of this section is also used for submission and routing of	1035
nonpharmacy claims, the designation "Rx" is required to be	1036
included as part of the labels identified in divisions (B)(2)(d)	1037
and (e) of this section if the issuer's international	1038
identification number or the processor's control number is	1039
different for medical and pharmacy claims.	1040

(D) Each sickness and accident insurer described in division	1041
(A) of this section shall annually file a certificate with the	1042
superintendent of insurance certifying that it or any person it	1043
contracts with to issue a standardized identification card or	1044
electronic technology for submission and routing of prescription	1045
drug claims complies with this section.	1046

(E)(1) Except as provided in division (E)(2) of this section,	1047
if there is a change in the information contained in the	1048
standardized identification card or the electronic technology	1049
issued to an insured, the insurer or person under contract with	1050
the insurer to issue a standardized identification card or an	1051
electronic technology shall issue a new card or electronic	1052
technology to the insured.	1053

(2) An insurer or person under contract with the insurer is	1054
not required under division (E)(1) of this section to issue a new	1055
card or electronic technology to an insured more than once during	1056
a twelve-month period.	1057

(F) Nothing in this section shall be construed as requiring	1058
an insurer to produce more than one standardized identification	1059
card or one electronic technology for use by insureds accessing	1060
health care benefits provided under a policy of sickness and	1061
accident insurance.	1062

Sec. 3923.65.  (A) As used in this section:

1063

(1) "Emergency medical condition" means a medical condition	1064
that manifests itself by such acute symptoms of sufficient	1065
severity, including severe pain, that a prudent layperson with	1066
average knowledge of health and medicine could reasonably expect	1067
the absence of immediate medical attention to result in any of the	1068
following:	1069

(a) Placing the health of the individual or, with respect to	1070
a pregnant woman, the health of the woman or her unborn child, in	1071
serious jeopardy;	1072

(b) Serious impairment to bodily functions;

1073

(c) Serious dysfunction of any bodily organ or part.

1074

(2) "Emergency services" means the following:

1075

(a) A medical screening examination, as required by federal	1076
law, that is within the capability of the emergency department of	1077
a hospital, including ancillary services routinely available to	1078
the emergency department, to evaluate an emergency medical	1079
condition;	1080

(b) Such further medical examination and treatment that are	1081
required by federal law to stabilize an emergency medical	1082
condition and are within the capabilities of the staff and	1083
facilities available at the hospital, including any trauma and	1084
burn center of the hospital.	1085

(B) Every individual or group policy of sickness and accident	1086
insurance that provides hospital, surgical, or medical expense	1087
coverage shall cover emergency services without regard to the day	1088
or time the emergency services are rendered or to whether the	1089
policyholder, the hospital's emergency department where the	1090
services are rendered, or an emergency physician treating the	1091
policyholder, obtained prior authorization for the emergency	1092
services.	1093

(C) Every individual policy or certificate furnished by an	1094
insurer in connection with any sickness and accident insurance	1095
policy shall provide information regarding the following:	1096

(1) The scope of coverage for emergency services;

1097

(2) The appropriate use of emergency services, including the	1098
use of the 9-1-1 system and any other telephone access systems	1099
utilized to access prehospital emergency services;	1100

(3) Any copayments for emergency services.

1101

(D) This section does not apply to any individual or group	1102
policy of sickness and accident insurance covering only accident,	1103
credit, dental, disability income, long-term care, hospital	1104
indemnity, medicare supplement, medicare, tricare, specified	1105
disease, or vision care; coverage under a one-time limited	1106
duration policy of no longerthat is less than sixtwelve months;	1107
coverage issued as a supplement to liability insurance; insurance	1108
arising out of workers' compensation or similar law; automobile	1109
medical payment insurance; or insurance under which benefits are	1110
payable with or without regard to fault and which is statutorily	1111
required to be contained in any liability insurance policy or	1112
equivalent self-insurance.	1113

Sec. 3923.83. (A)(1) This section applies to both of the	1114
following:	1115

(a) A public employee benefit plan that issues or requires	1116
the use of a standardized identification card or an electronic	1117
technology for submission and routing of prescription drug claims	1118
pursuant to a policy, contract, or agreement for health care	1119
services;	1120

(b) A person or entity that a public employee benefit plan	1121
contracts with to issue a standardized identification card or an	1122
electronic technology described in division (A)(1)(a) of this	1123
section.	1124

(2) Notwithstanding division (A)(1) of this section, this	1125
section does not apply to the issuance or required use of a	1126
standardized identification card or an electronic technology for	1127
the submission and routing of prescription drug claims in	1128
connection with either of the following:	1129

(a) Any individual or group policy of insurance covering only	1130
accident, credit, dental, disability income, long-term care,	1131
hospital indemnity, medicare supplement, medicare, tricare,	1132
specified disease, or vision care; coverage under a	1133
one-time-limited-duration policy of not longerthat is less than	1134
sixtwelve months; coverage issued as a supplement to liability	1135
insurance; insurance arising out of workers' compensation or	1136
similar law; automobile medical payment insurance; or insurance	1137
under which benefits are payable with or without regard to fault	1138
and which is statutorily required to be contained in any liability	1139
insurance policy or equivalent self-insurance.	1140

(b) Coverage provided under the medicaid program.

1141

(B) A standardized identification card or an electronic	1142
technology issued or required to be used as provided in division	1143
(A)(1) of this section shall contain uniform prescription drug	1144
information in accordance with either division (B)(1) or (2) of	1145
this section.	1146

(1) The standardized identification card or the electronic	1147
technology shall be in a format and contain information fields	1148
approved by the national council for prescription drug programs or	1149
a successor organization, as specified in the council's or	1150
successor organization's pharmacy identification card	1151
implementation guide in effect on the first day of October most	1152
immediately preceding the issuance or required use of the	1153
standardized identification card or the electronic technology.	1154

(2) If the public employee benefit plan or person under	1155
contract with the plan to issue a standardized identification card	1156
or an electronic technology requires the information for the	1157
submission and routing of a claim, the standardized identification	1158
card or the electronic technology shall contain any of the	1159
following information:	1160

(a) The plan's name;

1161

(b) The insured's name, group number, and identification	1162
number;	1163

(c) A telephone number to inquire about pharmacy-related	1164
issues;	1165

(d) The issuer's international identification number, labeled	1166
as "ANSI BIN" or "RxBIN";	1167

(e) The processor's control number, labeled as "RxPCN";

1168

(f) The insured's pharmacy benefits group number if different	1169
from the insured's medical group number, labeled as "RxGrp."	1170

(C) If the standardized identification card or the electronic	1171
technology issued or required to be used as provided in division	1172
(A)(1) of this section is also used for submission and routing of	1173
nonpharmacy claims, the designation "Rx" is required to be	1174
included as part of the labels identified in divisions (B)(2)(d)	1175
and (e) of this section if the issuer's international	1176
identification number or the processor's control number is	1177
different for medical and pharmacy claims.	1178

(D)(1) Except as provided in division (D)(2) of this section,	1179
if there is a change in the information contained in the	1180
standardized identification card or the electronic technology	1181
issued to an insured, the public employee benefit plan or person	1182
under contract with the plan to issue a standardized	1183
identification card or electronic technology shall issue a new	1184
card or electronic technology to the insured.	1185

(2) A public employee benefit plan or person under contract	1186
with the plan is not required under division (D)(1) of this	1187
section to issue a new card or electronic technology to an insured	1188
more than once during a twelve-month period.	1189

(E) Nothing in this section shall be construed as requiring a	1190
public employee benefit plan to produce more than one standardized	1191
identification card or one electronic technology for use by	1192
insureds accessing health care benefits provided under a health	1193
benefit plan.	1194

Sec. 3923.85.  (A) As used in this section, "cost sharing"	1195
means the cost to an individual insured under an individual or	1196
group policy of sickness and accident insurance or a public	1197
employee benefit plan according to any coverage limit, copayment,	1198
coinsurance, deductible, or other out-of-pocket expense	1199
requirements imposed by the policy or plan.	1200

(B) Notwithstanding section 3901.71 of the Revised Code and	1201
subject to division (D) of this section, no individual or group	1202
policy of sickness and accident insurance that is delivered,	1203
issued for delivery, or renewed in this state and no public	1204
employee benefit plan that is established or modified in this	1205
state shall fail to comply with either of the following:	1206

(1) The policy or plan shall not provide coverage or impose	1207
cost sharing for a prescribed, orally administered cancer	1208
medication on a less favorable basis than the coverage it provides	1209
or cost sharing it imposes for intraveneously administered or	1210
injected cancer medications.	1211

(2) The policy or plan shall not comply with division (B)(1)	1212
of this section by imposing an increase in cost sharing solely for	1213
orally administered, intravenously administered, or injected	1214
cancer medications.	1215

(C) Notwithstanding any provision of this section to the	1216
contrary, a policy or plan shall be deemed to be in compliance	1217
with this section if the cost sharing imposed under such a policy	1218
or plan for orally administered cancer treatments does not exceed	1219
one hundred dollars per prescription fill. The cost sharing limit	1220
of one hundred dollars per prescription fill shall apply to a high	1221
deductible plan, as defined in 26 U.S.C. 223, or a catastrophic	1222
plan, as defined in 42 U.S.C. 18022, only after the deductible has	1223
been met.	1224

(D)(1) The prohibitions in division (B) of this section do	1225
not preclude an individual or group policy of sickness and	1226
accident insurance or public employee benefit plan from requiring	1227
an insured or plan member to obtain prior authorization before	1228
orally administered cancer medication is dispensed to the insured	1229
or plan member.	1230

(2) Division (B) of this section does not apply to the offer	1231
or renewal of any individual or group policy of sickness and	1232
accident insurance that provides coverage for specific diseases or	1233
accidents only, or to any hospital indemnity, medicare supplement,	1234
disability income, or other policy that offers only supplemental	1235
benefits.	1236

(E) An insurer that offers any sickness and accident	1237
insurance or any public employee benefit plan that offers coverage	1238
for basic health care services is not required to comply with	1239
division (B) of this section if all of the following apply:	1240

(1) The insurer or plan submits documentation certified by an	1241
independent member of the American academy of actuaries to the	1242
superintendent of insurance showing that compliance with division	1243
(B)(1) of this section for a period of at least six months	1244
independently caused the insurer or plan's costs for claims and	1245
administrative expenses for the coverage of basic health care	1246
services to increase by more than one per cent per year.	1247

(2) The insurer or plan submits a signed letter from an	1248
independent member of the American academy of actuaries to the	1249
superintendent of insurance opining that the increase in costs	1250
described in division (E)(1) of this section could reasonably	1251
justify an increase of more than one per cent in the annual	1252
premiums or rates charged by the insurer or plan for the coverage	1253
of basic health care services.	1254

(3)(a) The superintendent of insurance makes the following	1255
determinations from the documentation and opinion submitted	1256
pursuant to divisions (E)(1) and (2) of this section:	1257

(i) Compliance with division (B)(1) of this section for a	1258
period of at least six months independently caused the insurer or	1259
plan's costs for claims and administrative expenses for the	1260
coverage of basic health care services to increase more than one	1261
per cent per year.	1262

(ii) The increase in costs reasonably justifies an increase	1263
of more than one per cent in the annual premiums or rates charged	1264
by the insurer or plan for the coverage of basic health care	1265
services.	1266

(b) Any determination made by the superintendent under	1267
division (E)(3) of this section is subject to Chapter 119. of the	1268
Revised Code.	1269

Sec. 3924.01.  As used in sections 3924.01 to 3924.14 of the	1270
Revised Code:	1271

(A) "Actuarial certification" means a written statement	1272
prepared by a member of the American academy of actuaries, or by	1273
any other person acceptable to the superintendent of insurance,	1274
that states that, based upon the person's examination, a carrier	1275
offering health benefit plans to small employers is in compliance	1276
with sections 3924.01 to 3924.14 of the Revised Code. "Actuarial	1277
certification" shall include a review of the appropriate records	1278
of, and the actuarial assumptions and methods used by, the carrier	1279
relative to establishing premium rates for the health benefit	1280
plans.	1281

(B) "Adjusted average market premium price" means the average	1282
market premium price as determined by the board of directors of	1283
the Ohio health reinsurance program either on the basis of the	1284
arithmetic mean of all carriers' premium rates for an OHC plan	1285
sold to groups with similar case characteristics by all carriers	1286
selling OHC plans in the state, or on any other equitable basis	1287
determined by the board.	1288

(C) "Base premium rate" means, as to any health benefit plan	1289
that is issued by a carrier and that covers at least two but no	1290
more than fifty employees of a small employer, the lowest premium	1291
rate for a new or existing business prescribed by the carrier for	1292
the same or similar coverage under a plan or arrangement covering	1293
any small employer with similar case characteristics.	1294

(D) "Carrier" means any sickness and accident insurance	1295
company or health insuring corporation authorized to issue health	1296
benefit plans in this state or a MEWA. A sickness and accident	1297
insurance company that owns or operates a health insuring	1298
corporation, either as a separate corporation or as a line of	1299
business, shall be considered as a separate carrier from that	1300
health insuring corporation for purposes of sections 3924.01 to	1301
3924.14 of the Revised Code.	1302

(E) "Case characteristics" means, with respect to a small	1303
employer, the geographic area in which the employees work; the age	1304
and sex of the individual employees and their dependents; the	1305
appropriate industry classification as determined by the carrier;	1306
the number of employees and dependents; and such other objective	1307
criteria as may be established by the carrier. "Case	1308
characteristics" does not include claims experience, health	1309
status, or duration of coverage from the date of issue.	1310

(F) "Dependent" means the spouse or child of an eligible	1311
employee, subject to applicable terms of the health benefits plan	1312
covering the employee.	1313

(G) "Eligible employee" means an employee who works a normal	1314
work week of twenty-fivethirty or more hours. "Eligible employee"	1315
does not include a temporary or substitute employee, or a seasonal	1316
employee who works only part of the calendar year on the basis of	1317
natural or suitable times or circumstances.	1318

(H) "Health benefit plan" means any hospital or medical	1319
expense policy or certificate or any health plan provided by a	1320
carrier, that is delivered, issued for delivery, renewed, or used	1321
in this state on or after the date occurring six months after	1322
November 24, 1995. "Health benefit plan" does not include policies	1323
covering only accident, credit, dental, disability income,	1324
long-term care, hospital indemnity, medicare supplement, specified	1325
disease, or vision care; coverage under a	1326
one-time-limited-duration policy of no longerthat is less than	1327
sixtwelve months; coverage issued as a supplement to liability	1328
insurance; insurance arising out of a workers' compensation or	1329
similar law; automobile medical-payment insurance; or insurance	1330
under which benefits are payable with or without regard to fault	1331
and which is statutorily required to be contained in any liability	1332
insurance policy or equivalent self-insurance.	1333

(I) "Late enrollee" means an eligible employee or dependent	1334
who enrolls in a small employer's health benefit plan other than	1335
during the first period in which the employee or dependent is	1336
eligible to enroll under the plan or during a special enrollment	1337
period described in section 2701(f) of the "Health Insurance	1338
Portability and Accountability Act of 1996," Pub. L. No. 104-191,	1339
110 Stat. 1955, 42 U.S.C.A. 300gg, as amended.	1340

(J) "MEWA" means any "multiple employer welfare arrangement"	1341
as defined in section 3 of the "Federal Employee Retirement Income	1342
Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended,	1343
except for any arrangement which is fully insured as defined in	1344
division (b)(6)(D) of section 514 of that act.	1345

(K) "Midpoint rate" means, for small employers with similar	1346
case characteristics and plan designs and as determined by the	1347
applicable carrier for a rating period, the arithmetic average of	1348
the applicable base premium rate and the corresponding highest	1349
premium rate.	1350

(L) "Pre-existing conditions provision" means a policy	1351
provision that excludes or limits coverage for charges or expenses	1352
incurred during a specified period following the insured's	1353
enrollment date as to a condition for which medical advice,	1354
diagnosis, care, or treatment was recommended or received during a	1355
specified period immediately preceding the enrollment date.	1356
Genetic information shall not be treated as such a condition in	1357
the absence of a diagnosis of the condition related to such	1358
information.	1359

For purposes of this division, "enrollment date" means, with	1360
respect to an individual covered under a group health benefit	1361
plan, the date of enrollment of the individual in the plan or, if	1362
earlier, the first day of the waiting period for such enrollment.	1363

(M) "Service waiting period" means the period of time after	1364
employment begins before an employee is eligible to be covered for	1365
benefits under the terms of any applicable health benefit plan	1366
offered by the small employer.	1367

(N)(1) "Small employer" means, in connection with a group	1368
health benefit plan and with respect to a calendar year and a plan	1369
year, an employer who employed an average of at least two but no	1370
more than fifty eligible employees on business days during the	1371
preceding calendar year and who employs at least two employees on	1372
the first day of the plan year.	1373

(2) For purposes of division (N)(1) of this section, all	1374
persons treated as a single employer under subsection (b), (c),	1375
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	1376
100 Stat. 2085, 26 U.S.C.A. 1, as amended, shall be considered one	1377
employer. In the case of an employer that was not in existence	1378
throughout the preceding calendar year, the determination of	1379
whether the employer is a small or large employer shall be based	1380
on the average number of eligible employees that it is reasonably	1381
expected the employer will employ on business days in the current	1382
calendar year. Any reference in division (N) of this section to an	1383
"employer" includes any predecessor of the employer. Except as	1384
otherwise specifically provided, provisions of sections 3924.01 to	1385
3924.14 of the Revised Code that apply to a small employer that	1386
has a health benefit plan shall continue to apply until the plan	1387
anniversary following the date the employer no longer meets the	1388
requirements of this division.	1389

(O) "OHC plan" means an Ohio health care plan, which is the	1390
basic, standard, or carrier reimbursement plan for small employers	1391
and individuals established in accordance with section 3924.10 of	1392
the Revised Code.	1393

Sec. 5301.36.  (A) Except in a county in which the county	1394
recorder has elected to require that all satisfactions of	1395
mortgages be recorded by separate instrument as allowed under	1396
section 5301.28 of the Revised Code, when recording a mortgage,	1397
county recorders shall leave space on the margin of the record for	1398
the entry of satisfaction, and record therein the satisfaction	1399
made on the mortgage, or permit the owner of the claim secured by	1400
the mortgage to enter such satisfaction. Such record shall have	1401
the same effect as the record of a release of the mortgage.	1402

(B) Within ninety days from the date of the satisfaction of a	1403
residential mortgage, the mortgagee shall record a release of the	1404
mortgage evidencing the fact of theits satisfaction in the	1405
appropriate county recorder's office and pay any fees required for	1406
the recording. The mortgagee may, by contract with the mortgagor,	1407
recover the cost of the fees required for the recording of the	1408
satisfaction by the county recorder.	1409

(C) If the mortgagee fails to comply with division (B) of	1410
this section, the mortgagor of the unrecorded satisfaction and the	1411
current owner of the real property to which the mortgage pertains	1412
may recover, in a civil action, damages of two hundred fifty	1413
dollars. This division does not preclude or affect any other legal	1414
remedies or damages that may be available to the mortgagor.	1415

(D)(1) If upon the expiration of the ninety-day period	1416
described in division (B) of this section, the satisfaction of	1417
mortgage remains unrecorded, the current owner of the real	1418
property shall provide the mortgagee written notice, in accordance	1419
with the Rules of Civil Procedure, of the failure to enter the	1420
release of the mortgage of record. The notice shall be in	1421
substantially the following form:	1422

"OHIO LAW REQUIRES A MORTGAGEE, WHETHER THE ORIGINAL MORTGAGEE OR	1423
ANY SUCCESSOR TO THE INTEREST OF THE ORIGINAL MORTGAGEE, TO RECORD	1424
A RELEASE OF A MORTGAGE EVIDENCING ITS SATISFACTION IN THE	1425
APPROPRIATE COUNTY RECORDER'S OFFICE AND TO PAY ANY FEES REQUIRED	1426
FOR THE RECORDING WITHIN A CERTAIN TIME PERIOD. (Name of	1427
mortgagor)'S MORTGAGE LOAN, (loan number or other loan	1428
identification), FOR PROPERTY LOCATED AT (property address), WAS	1429
SATISFIED ON (date of satisfaction). IT APPEARS YOU HAVE YET TO	1430
RECORD A RELEASE OF THIS MORTGAGE. FAILURE TO RECORD THE RELEASE	1431
WITHIN 15 DAYS OF RECEIVING THIS NOTICE MAY RESULT IN A CIVIL	1432
ACTION FILED AGAINST YOU TO RECOVER REASONABLE ATTORNEYS' FEES AND	1433
COSTS INCURRED IN SUCH AN ACTION OR OTHERWISE TO OBTAIN THE	1434
RECORDING, PLUS DAMAGES OF $100 FOR EACH DAY OF NONCOMPLIANCE NOT	1435
TO EXCEED $5,000 IN TOTAL DAMAGES."	1436

(2) Within fifteen days after delivery of the notice	1437
described in division (D)(1) of this section, the mortgagee shall	1438
record a release of the mortgage evidencing the fact of its	1439
satisfaction in the appropriate county recorder's office and pay	1440
any fees required for the recording. The mortgagee may, by	1441
contract with the mortgagor or current owner of the real property,	1442
recover the cost of the fees required for the recording of the	1443
satisfaction by the county recorder.	1444

(E) If the mortgagee fails to comply with division (D)(2) of	1445
this section after receiving the notice in accordance with	1446
division (D)(1) of this section, the current owner of the real	1447
property may recover, in a civil action, reasonable attorneys'	1448
fees and costs incurred in such an action or otherwise to obtain	1449
the recording of a satisfaction of mortgage plus damages of one	1450
hundred dollars for each day of noncompliance, not to exceed five	1451
thousand dollars in total damages.	1452

This division does not preclude or affect any other legal	1453
remedies or damages that may be available to the current owner.	1454

(F) A mortgagee that records a release of a mortgage	1455
evidencing the fact of its satisfaction within the time periods	1456
required by this section shall not be in violation of this	1457
section, or subject to damages or fees, due to the failure of a	1458
county recorder to timely process that release of mortgage.	1459

(G) A current owner may combine the civil actions described	1460
in divisions (C) and (E) of this section by bringing one action to	1461
collect for both damages, or may bring separate actions.	1462

(H) As used in this section, "residential mortgage" means an	1463
obligation to pay a sum of money evidenced by a note and secured	1464
by a lien upon:	1465

(1) "Mortgagee" includes the original mortgagee or any	1466
successor to or assignee of the original mortgagee.	1467

(2) realproperty located within this state containing two	1468
or fewer residential units or on which two or fewer residential	1469
units are to be constructed and shall include such an	1470
"Satisfaction" means that the obligation on a residential	1471
condominium or cooperative unit secured by a mortgage has been	1472
paid in full and the underlying obligation terminated, with no	1473
opportunities for future advancements.	1474

Sec. 5301.361. (A)(1) With respect to an unreleased	1475
commercial mortgage that has been satisfied more than ninety days	1476
prior to the effective date of this section, but not recorded, the	1477
mortgagee shall not be subject to a civil action or damages as	1478
described in division (C) of section 5301.36 of the Revised Code.	1479

(2) The current owner of the real property to which such a	1480
mortgage pertains shall provide the mortgagee the written notice	1481
described in division (D)(1) of section 5301.36 of the Revised	1482
Code not sooner than on the effective date of this section and may	1483
recover damages in a civil action for failure to comply with	1484
division (D)(2) of that section pursuant to division (E) of that	1485
section.	1486

(B)(1) With respect to an unreleased commercial mortgage that	1487
has been satisfied less than ninety days prior to the effective	1488
date of this section, but not recorded, the mortgagee shall not be	1489
subject to a civil action or damages as described in division (C)	1490
of section 5301.36 of the Revised Code.	1491

(2) The current owner of the real property to which such a	1492
mortgage pertains shall provide the mortgagee the written notice	1493
described in division (D)(1) of section 5301.36 of the Revised	1494
Code not sooner than on the ninetieth day after the mortgage was	1495
satisfied and may recover damages in a civil action for failure to	1496
comply with division (D)(2) of that section pursuant to division	1497
(E) of that section.	1498

(C)(1) With respect to an unreleased residential mortgage	1499
that has been satisfied, but not recorded, prior to the effective	1500
date of this section, the mortgagee shall be subject to a civil	1501
action or damages as described in division (C) of section 5301.36	1502
of the Revised Code for failure to comply with division (B) of	1503
that section.	1504

(2) If such a mortgage was satisfied more than ninety days	1505
prior to the effective date of this section, the current owner of	1506
the real property to which the mortgage pertains shall provide the	1507
mortgagee the written notice described in division (D)(1) of	1508
section 5301.36 of the Revised Code not sooner than on the	1509
effective date of this section and may recover damages in a civil	1510
action for failure to comply with division (D)(2) of that section	1511
pursuant to division (E) of that section. If such a mortgage was	1512
satisfied less than ninety days prior to the effective date of the	1513
section, the current owner shall provide the mortgagee the written	1514
notice described in division (D)(1) of section 5301.36 of the	1515
Revised Code not sooner than on the ninetieth day after the	1516
mortgage was satisfied and may recover damages in a civil action	1517
for failure to comply with division (D)(2) of that section	1518
pursuant to division (E) of that section.	1519

(D) As used in this section, "mortgagee" has the same meaning	1520
as in section 5301.36 of the Revised Code.	1521

Section 2. That existing sections 1739.061, 1751.14, 1751.69,	1522
3923.022, 3923.24, 3923.241, 3923.281, 3923.57, 3923.58, 3923.601,	1523
3923.65, 3923.83, 3923.85, 3924.01, and 5301.36 of the Revised	1524
Code are hereby repealed.	1525

Section 3. Section 1751.14 and division (G) of section	1526
3924.01 of the Revised Code, as amended by this act, apply only to	1527
policies, contracts, and agreements that are delivered, issued for	1528
delivery, or renewed in this state on or after January 1, 2016.	1529
Division (A)(1) of section 3923.24 and division (A)(1) of section	1530
3923.241 of the Revised Code, as amended by this act, apply only	1531
to policies of sickness and accident insurance delivered, issued	1532
for delivery, or renewed in this state and public employee benefit	1533
plans or multiple employer welfare arrangement contracts and	1534
certificates that are established or modified in this state on or	1535
after January 1, 2016.	1536

Section 4. The General Assembly declares that the amendments	1537
made to section 3923.58 of the Revised Code by this act are not to	1538
supersede the suspension of the operation of this section enacted	1539
by Section 3 of Sub. S.B. 9 of the 130th General Assembly. Rather,	1540
it is the intent of the General Assembly to ensure consistency in	1541
Ohio Insurance Law should this suspension be nullified.	1542