As Reported by the House Health and Aging Committee

130th General Assembly Regular Session 2013-2014

Am. H. B. No. 511

Representative Sears 

Cosponsors: Representatives Boose, Grossman, Henne, Romanchuk, Smith, Wachtmann, Young 

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A BILL

To amend sections 1751.14, 3923.24, 3923.241, and

1

3924.01, to enact sections 505.377, 737.082, and

2

737.222 of the Revised Code to clarify the status

3

of volunteer firefighters for purposes of the

4

Patient Protection and Affordable Care Act and to

5

make changes regarding coverage for a dependent

6

child under a parent's health insurance plan and

7

the hours of work needed to qualify for coverage

8

under a small employer health benefit plan.

9

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

Section 1. That sections 1751.14, 3923.24, 3923.241, and	10
3924.01 be amended and sections 505.377, 737.082, and 737.222 of	11
the Revised Code be enacted to read as follows:	12

Sec. 505.377.  A volunteer firefighter appointed pursuant to	13
this chapter is a bona fide volunteer and not an employee for	14
purposes of section 513 of the "Patient Protection and Affordable	15
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	16
providing those fire protection services, the volunteer receives	17
any of the benefits provided in Chapter 146., 4121., or 4123. or	18
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	19
Code.	20

Sec. 737.082.  A volunteer firefighter appointed pursuant to	21
this chapter is a bona fide volunteer and not an employee for	22
purposes of section 513 of the "Patient Protection and Affordable	23
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	24
providing those fire protection services, the volunteer receives	25
any of the benefits provided in Chapter 146., 4121., or 4123. or	26
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	27
Code.	28

Sec. 737.222.  A volunteer firefighter appointed pursuant to	29
this chapter is a bona fide volunteer and not an employee for	30
purposes of section 513 of the "Patient Protection and Affordable	31
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	32
providing those fire protection services, the volunteer receives	33
any of the benefits provided in Chapter 146., 4121., or 4123. or	34
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	35
Code.	36

Sec. 1751.14.  (A) Notwithstanding section 3901.71 of the	37
Revised Code, any policy, contract, or agreement for health care	38
services authorized by this chapter that is issued, delivered, or	39
renewed in this state and that provides that coverage of an	40
unmarried dependent child will terminate upon attainment of the	41
limiting age for dependent children specified in the policy,	42
contract, or agreement, shall also provide in substance both of	43
the following:	44

(1) Once an unmarried child has attained the limiting age for	45
dependent children, as provided in the policy, contract, or	46
agreement, upon the request of the subscriber, the health insuring	47
corporation shall offer to cover the unmarried child until the	48
child attains twenty-eighttwenty-six years of age if all of the	49
following are true:	50

(a) The child is the natural child, stepchild, or adopted	51
child of the subscriber.	52

(b) The child is a resident of this state or a full-time	53
student at an accredited public or private institution of higher	54
education.	55

(c) The child is not employed by an employer that offers any	56
health benefit plan under which the child is eligible for	57
coverage.	58

(d) The child is not eligible for coverage under the medicaid	59
program or the medicare program.	60

(2) That attainment of the limiting age for dependent	61
children shall not operate to terminate the coverage of a	62
dependent child if the child is and continues to be both of the	63
following:	64

(a) Incapable of self-sustaining employment by reason of	65
mental retardation or physical handicap;	66

(b) Primarily dependent upon the subscriber for support and	67
maintenance.	68

(B) Proof of incapacity and dependence for purposes of	69
division (A)(2) of this section shall be furnished to the health	70
insuring corporation within thirty-one days of the child's	71
attainment of the limiting age. Upon request, but not more	72
frequently than annually, the health insuring corporation may	73
require proof satisfactory to it of the continuance of such	74
incapacity and dependency.	75

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

76

(1) Require that any policy, contract, or agreement offer	77
coverage for dependent children or provide coverage for an	78
unmarried dependent child's children as dependents on the policy,	79
contract, or agreement;	80

(2) Require an employer to pay for any part of the premium	81
for an unmarried dependent child that has attained the limiting	82
age for dependents, as provided in the policy, contract, or	83
agreement;	84

(3) Require an employer to offer health insurance coverage to	85
the dependents of any employee.	86

(D) This section does not apply to any health insuring	87
corporation policy, contract, or agreement offering only	88
supplemental health care services or specialty health care	89
services.	90

(E) As used in this section, "health benefit plan" has the	91
same meaning as in section 3924.01 of the Revised Code and also	92
includes both of the following:	93

(1) A public employee benefit plan;

94

(2) A health benefit plan as regulated under the "Employee	95
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	96

Sec. 3923.24.  (A) Notwithstanding section 3901.71 of the	97
Revised Code, every certificate furnished by an insurer in	98
connection with, or pursuant to any provision of, any group	99
sickness and accident insurance policy delivered, issued for	100
delivery, renewed, or used in this state on or after January 1,	101
1972, every policy of sickness and accident insurance delivered,	102
issued for delivery, renewed, or used in this state on or after	103
January 1, 1972, and every multiple employer welfare arrangement	104
offering an insurance program, which provides that coverage of an	105
unmarried dependent child of a parent or legal guardian will	106
terminate upon attainment of the limiting age for dependent	107
children specified in the contract shall also provide in substance	108
both of the following:	109

(1) Once an unmarried child has attained the limiting age for	110
dependent children, as provided in the policy, upon the request of	111
the insured, the insurer shall offer to cover the unmarried child	112
until the child attains twenty-eighttwenty-six years of age if	113
all of the following are true:	114

(a) The child is the natural child, stepchild, or adopted	115
child of the insured.	116

(b) The child is a resident of this state or a full-time	117
student at an accredited public or private institution of higher	118
education.	119

(c) The child is not employed by an employer that offers any	120
health benefit plan under which the child is eligible for	121
coverage.	122

(d) The child is not eligible for the medicaid program or the	123
medicare program.	124

(2) That attainment of the limiting age for dependent	125
children shall not operate to terminate the coverage of a	126
dependent child if the child is and continues to be both of the	127
following:	128

(a) Incapable of self-sustaining employment by reason of	129
mental retardation or physical handicap;	130

(b) Primarily dependent upon the policyholder or certificate	131
holder for support and maintenance.	132

(B) Proof of such incapacity and dependence for purposes of	133
division (A)(2) of this section shall be furnished by the	134
policyholder or by the certificate holder to the insurer within	135
thirty-one days of the child's attainment of the limiting age.	136
Upon request, but not more frequently than annually after the	137
two-year period following the child's attainment of the limiting	138
age, the insurer may require proof satisfactory to it of the	139
continuance of such incapacity and dependency.	140

(C) Nothing in this section shall require an insurer to cover	141
a dependent child who is mentally retarded or physically	142
handicapped if the contract is underwritten on evidence of	143
insurability based on health factors set forth in the application,	144
or if such dependent child does not satisfy the conditions of the	145
contract as to any requirement for evidence of insurability or	146
other provision of the contract, satisfaction of which is required	147
for coverage thereunder to take effect. In any such case, the	148
terms of the contract shall apply with regard to the coverage or	149
exclusion of the dependent from such coverage. Nothing in this	150
section shall apply to accidental death or dismemberment benefits	151
provided by any such policy of sickness and accident insurance.	152

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

153

(1) Require that any policy offer coverage for dependent	154
children or provide coverage for an unmarried dependent child's	155
children as dependents on the policy;	156

(2) Require an employer to pay for any part of the premium	157
for an unmarried dependent child that has attained the limiting	158
age for dependents, as provided in the policy;	159

(3) Require an employer to offer health insurance coverage to	160
the dependents of any employee.	161

(E) This section does not apply to any policies or	162
certificates covering only accident, credit, dental, disability	163
income, long-term care, hospital indemnity, medicare supplement,	164
specified disease, or vision care; coverage under a	165
one-time-limited-duration policy of not longer than six months;	166
coverage issued as a supplement to liability insurance; insurance	167
arising out of a workers' compensation or similar law; automobile	168
medical-payment insurance; or insurance under which benefits are	169
payable with or without regard to fault and that is statutorily	170
required to be contained in any liability insurance policy or	171
equivalent self-insurance.	172

(F) As used in this section, "health benefit plan" has the	173
same meaning as in section 3924.01 of the Revised Code and also	174
includes both of the following:	175

(1) A public employee benefit plan;

176

(2) A health benefit plan as regulated under the "Employee	177
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	178

Sec. 3923.241. (A) Notwithstanding section 3901.71 of the	179
Revised Code, any public employee benefit plan that provides that	180
coverage of an unmarried dependent child will terminate upon	181
attainment of the limiting age for dependent children specified in	182
the plan shall also provide in substance both of the following:	183

(1) Once an unmarried child has attained the limiting age for	184
dependent children, as provided in the plan, upon the request of	185
the employee, the public employee benefit plan shall offer to	186
cover the unmarried child until the child attains twenty-eight	187
twenty-six years of age if all of the following are true:	188

(a) The child is the natural child, stepchild, or adopted	189
child of the employee.	190

(b) The child is a resident of this state or a full-time	191
student at an accredited public or private institution of higher	192
education.	193

(c) The child is not employed by an employer that offers any	194
health benefit plan under which the child is eligible for	195
coverage.	196

(d) The child is not eligible for the medicaid program or the	197
medicare program.	198

(2) That attainment of the limiting age for dependent	199
children shall not operate to terminate the coverage of a	200
dependent child if the child is and continues to be both of the	201
following:	202

(a) Incapable of self-sustaining employment by reason of	203
mental retardation or physical handicap;	204

(b) Primarily dependent upon the plan member for support and	205
maintenance.	206

(B) Proof of incapacity and dependence for purposes of	207
division (A)(2) of this section shall be furnished to the public	208
employee benefit plan within thirty-one days of the child's	209
attainment of the limiting age. Upon request, but not more	210
frequently than annually, the public employee benefit plan may	211
require proof satisfactory to it of the continuance of such	212
incapacity and dependency.	213

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

214

(1) Require that any public employee benefit plan offer	215
coverage for dependent children or provide coverage for an	216
unmarried dependent child's children as dependents on the public	217
employee benefit plan;	218

(2) Require an employer to pay for any part of the premium	219
for an unmarried dependent child that has attained the limiting	220
age for dependents, as provided in the plan;	221

(3) Require an employer to offer health insurance coverage to	222
the dependents of any employee.	223

(D) This section does not apply to any public employee	224
benefit plan covering only accident, credit, dental, disability	225
income, long-term care, hospital indemnity, medicare supplement,	226
specified disease, or vision care; coverage under a	227
one-time-limited-duration policy of not longer than six months;	228
coverage issued as a supplement to liability insurance; insurance	229
arising out of a workers' compensation or similar law; automobile	230
medical-payment insurance; or insurance under which benefits are	231
payable with or without regard to fault and which is statutorily	232
required to be contained in any liability insurance policy or	233
equivalent self-insurance.	234

(E) As used in this section, "health benefit plan" has the	235
same meaning as in section 3924.01 of the Revised Code and also	236
includes both of the following:	237

(1) A public employee benefit plan;

238

(2) A health benefit plan as regulated under the "Employee	239
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	240

Sec. 3924.01.  As used in sections 3924.01 to 3924.14 of the	241
Revised Code:	242

(A) "Actuarial certification" means a written statement	243
prepared by a member of the American academy of actuaries, or by	244
any other person acceptable to the superintendent of insurance,	245
that states that, based upon the person's examination, a carrier	246
offering health benefit plans to small employers is in compliance	247
with sections 3924.01 to 3924.14 of the Revised Code. "Actuarial	248
certification" shall include a review of the appropriate records	249
of, and the actuarial assumptions and methods used by, the carrier	250
relative to establishing premium rates for the health benefit	251
plans.	252

(B) "Adjusted average market premium price" means the average	253
market premium price as determined by the board of directors of	254
the Ohio health reinsurance program either on the basis of the	255
arithmetic mean of all carriers' premium rates for an OHC plan	256
sold to groups with similar case characteristics by all carriers	257
selling OHC plans in the state, or on any other equitable basis	258
determined by the board.	259

(C) "Base premium rate" means, as to any health benefit plan	260
that is issued by a carrier and that covers at least two but no	261
more than fifty employees of a small employer, the lowest premium	262
rate for a new or existing business prescribed by the carrier for	263
the same or similar coverage under a plan or arrangement covering	264
any small employer with similar case characteristics.	265

(D) "Carrier" means any sickness and accident insurance	266
company or health insuring corporation authorized to issue health	267
benefit plans in this state or a MEWA. A sickness and accident	268
insurance company that owns or operates a health insuring	269
corporation, either as a separate corporation or as a line of	270
business, shall be considered as a separate carrier from that	271
health insuring corporation for purposes of sections 3924.01 to	272
3924.14 of the Revised Code.	273

(E) "Case characteristics" means, with respect to a small	274
employer, the geographic area in which the employees work; the age	275
and sex of the individual employees and their dependents; the	276
appropriate industry classification as determined by the carrier;	277
the number of employees and dependents; and such other objective	278
criteria as may be established by the carrier. "Case	279
characteristics" does not include claims experience, health	280
status, or duration of coverage from the date of issue.	281

(F) "Dependent" means the spouse or child of an eligible	282
employee, subject to applicable terms of the health benefits plan	283
covering the employee.	284

(G) "Eligible employee" means an employee who works a normal	285
work week of twenty-fivethirty or more hours. "Eligible employee"	286
does not include a temporary or substitute employee, or a seasonal	287
employee who works only part of the calendar year on the basis of	288
natural or suitable times or circumstances.	289

(H) "Health benefit plan" means any hospital or medical	290
expense policy or certificate or any health plan provided by a	291
carrier, that is delivered, issued for delivery, renewed, or used	292
in this state on or after the date occurring six months after	293
November 24, 1995. "Health benefit plan" does not include policies	294
covering only accident, credit, dental, disability income,	295
long-term care, hospital indemnity, medicare supplement, specified	296
disease, or vision care; coverage under a	297
one-time-limited-duration policy of no longer than six months;	298
coverage issued as a supplement to liability insurance; insurance	299
arising out of a workers' compensation or similar law; automobile	300
medical-payment insurance; or insurance under which benefits are	301
payable with or without regard to fault and which is statutorily	302
required to be contained in any liability insurance policy or	303
equivalent self-insurance.	304

(I) "Late enrollee" means an eligible employee or dependent	305
who enrolls in a small employer's health benefit plan other than	306
during the first period in which the employee or dependent is	307
eligible to enroll under the plan or during a special enrollment	308
period described in section 2701(f) of the "Health Insurance	309
Portability and Accountability Act of 1996," Pub. L. No. 104-191,	310
110 Stat. 1955, 42 U.S.C.A. 300gg, as amended.	311

(J) "MEWA" means any "multiple employer welfare arrangement"	312
as defined in section 3 of the "Federal Employee Retirement Income	313
Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended,	314
except for any arrangement which is fully insured as defined in	315
division (b)(6)(D) of section 514 of that act.	316

(K) "Midpoint rate" means, for small employers with similar	317
case characteristics and plan designs and as determined by the	318
applicable carrier for a rating period, the arithmetic average of	319
the applicable base premium rate and the corresponding highest	320
premium rate.	321

(L) "Pre-existing conditions provision" means a policy	322
provision that excludes or limits coverage for charges or expenses	323
incurred during a specified period following the insured's	324
enrollment date as to a condition for which medical advice,	325
diagnosis, care, or treatment was recommended or received during a	326
specified period immediately preceding the enrollment date.	327
Genetic information shall not be treated as such a condition in	328
the absence of a diagnosis of the condition related to such	329
information.	330

For purposes of this division, "enrollment date" means, with	331
respect to an individual covered under a group health benefit	332
plan, the date of enrollment of the individual in the plan or, if	333
earlier, the first day of the waiting period for such enrollment.	334

(M) "Service waiting period" means the period of time after	335
employment begins before an employee is eligible to be covered for	336
benefits under the terms of any applicable health benefit plan	337
offered by the small employer.	338

(N)(1) "Small employer" means, in connection with a group	339
health benefit plan and with respect to a calendar year and a plan	340
year, an employer who employed an average of at least two but no	341
more than fifty eligible employees on business days during the	342
preceding calendar year and who employs at least two employees on	343
the first day of the plan year.	344

(2) For purposes of division (N)(1) of this section, all	345
persons treated as a single employer under subsection (b), (c),	346
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	347
100 Stat. 2085, 26 U.S.C.A. 1, as amended, shall be considered one	348
employer. In the case of an employer that was not in existence	349
throughout the preceding calendar year, the determination of	350
whether the employer is a small or large employer shall be based	351
on the average number of eligible employees that it is reasonably	352
expected the employer will employ on business days in the current	353
calendar year. Any reference in division (N) of this section to an	354
"employer" includes any predecessor of the employer. Except as	355
otherwise specifically provided, provisions of sections 3924.01 to	356
3924.14 of the Revised Code that apply to a small employer that	357
has a health benefit plan shall continue to apply until the plan	358
anniversary following the date the employer no longer meets the	359
requirements of this division.	360

(O) "OHC plan" means an Ohio health care plan, which is the	361
basic, standard, or carrier reimbursement plan for small employers	362
and individuals established in accordance with section 3924.10 of	363
the Revised Code.	364

Section 2. That existing sections 1751.14, 3923.24, 3923.241,	365
and 3924.01 of the Revised Code are hereby repealed.	366

Section 3. Sections 1751.14, and 3924.01 as amended by this	367
act, apply only to policies, contracts, and agreements that are	368
delivered, issued for delivery, or renewed in this state on or	369
after January 1, 2015. Sections 3923.24 and 3923.241 as amended by	370
this act, apply only to policies of sickness and accident	371
insurance delivered, issued for delivery, or renewed in this state	372
and public or private employee benefit plans that are established	373
or modified in this state on or after January 1, 2015.	374