As Reported by the House Health and Aging Committee

130th General Assembly Regular Session 2013-2014

Sub. S. B. No. 54

Senators Kearney, Eklund 

Cosponsors: Senators Cafaro, Gentile, Smith, Sawyer, Tavares, Schiavoni, Turner, Lehner, Jones, Bacon, Balderson, Beagle, Burke, Coley, Faber, Gardner, Hite, Hughes, LaRose, Manning, Obhof, Oelslager, Patton, Peterson, Schaffer, Seitz, Skindell, Uecker, Widener 

Representatives Wachtmann, Brown 

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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, 4729.291, and 4729.541 and to enact

4

sections 505.377, 737.082, 737.222, 3702.40, and

5

4731.056 of the Revised Code to require a

6

mammography facility to include certain

7

information in the mammography report summary sent

8

to a patient under federal law if the patient's

9

mammogram demonstrates the presence of dense

10

breast tissue; to establish requirements regarding

11

controlled substances containing buprenorphine

12

used for the purpose of treating drug dependence

13

or addiction; to clarify the status of volunteer

14

firefighters for purposes of the Patient

15

Protection and Affordable Care Act; to make

16

changes regarding coverage for a dependent child

17

under a parent's health insurance plan and the

18

hours of work needed to qualify for coverage under

19

a small employer health benefit plan; to increase

20

the duration of the health insurance considered to

21

be short-term under certain insurance laws; and to

22

make changes to the chemotherapy parity law.

23

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

Section 1. That sections 1739.061, 1751.14, 1751.69,	24
3923.022, 3923.24, 3923.241, 3923.281, 3923.57, 3923.58, 3923.601,	25
3923.65, 3923.83, 3923.85, 3924.01, 4729.291, and 4729.541 be	26
amended and sections 505.377, 737.082, 737.222, 3702.40, and	27
4731.056 of the Revised Code be enacted to read as follows:	28

Sec. 505.377.  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. 737.082.  A volunteer firefighter appointed pursuant to	37
this chapter is a bona fide volunteer and not an employee for	38
purposes of section 513 of the "Patient Protection and Affordable	39
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	40
providing those fire protection services, the volunteer receives	41
any of the benefits provided in Chapter 146., 4121., or 4123. or	42
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	43
Code.	44

Sec. 737.222.  A volunteer firefighter appointed pursuant to	45
this chapter is a bona fide volunteer and not an employee for	46
purposes of section 513 of the "Patient Protection and Affordable	47
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	48
providing those fire protection services, the volunteer receives	49
any of the benefits provided in Chapter 146., 4121., or 4123. or	50
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	51
Code.	52

Sec. 1739.061. (A)(1) This section applies to both of the	53
following:	54

(a) A multiple employer welfare arrangement that issues or	55
requires the use of a standardized identification card or an	56
electronic technology for submission and routing of prescription	57
drug claims;	58

(b) A person or entity that a multiple employer welfare	59
arrangement contracts with to issue a standardized identification	60
card or an electronic technology described in division (A)(1)(a)	61
of this section.	62

(2) Notwithstanding division (A)(1) of this section, this	63
section does not apply to the issuance or required use of a	64
standardized identification card or an electronic technology for	65
the submission and routing of prescription drug claims in	66
connection with any of the following:	67

(a) Any program or arrangement covering only accident,	68
credit, dental, disability income, long-term care, hospital	69
indemnity, medicare supplement, medicare, tricare, specified	70
disease, or vision care; coverage under a	71
one-time-limited-duration policy of not longerthat is less than	72
sixtwelve months; coverage issued as a supplement to liability	73
insurance; insurance arising out of workers' compensation or	74
similar law; automobile medical payment insurance; or insurance	75
under which benefits are payable with or without regard to fault	76
and which is statutorily required to be contained in any liability	77
insurance policy or equivalent self-insurance.	78

(b) Coverage provided under the medicaid program.

79

(c) Coverage provided under an employer's self-insurance plan	80
or by any of its administrators, as defined in section 3959.01 of	81
the Revised Code, to the extent that federal law supersedes,	82
preempts, prohibits, or otherwise precludes the application of	83
this section to the plan and its administrators.	84

(B) A standardized identification card or an electronic	85
technology issued or required to be used as provided in division	86
(A)(1) of this section shall contain uniform prescription drug	87
information in accordance with either division (B)(1) or (2) of	88
this section.	89

(1) The standardized identification card or the electronic	90
technology shall be in a format and contain information fields	91
approved by the national council for prescription drug programs or	92
a successor organization, as specified in the council's or	93
successor organization's pharmacy identification card	94
implementation guide in effect on the first day of October most	95
immediately preceding the issuance or required use of the	96
standardized identification card or the electronic technology.	97

(2) If the multiple employer welfare arrangement or person	98
under contract with it to issue a standardized identification card	99
or an electronic technology requires the information for the	100
submission and routing of a claim, the standardized identification	101
card or the electronic technology shall contain any of the	102
following information:	103

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

104

(b) The individual's name, group number, and identification	105
number;	106

(c) A telephone number to inquire about pharmacy-related	107
issues;	108

(d) The issuer's international identification number, labeled	109
as "ANSI BIN" or "RxBIN";	110

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

111

(f) The individual's pharmacy benefits group number if	112
different from the insured's medical group number, labeled as	113
"RxGrp."	114

(C) If the standardized identification card or the electronic	115
technology issued or required to be used as provided in division	116
(A)(1) of this section is also used for submission and routing of	117
nonpharmacy claims, the designation "Rx" is required to be	118
included as part of the labels identified in divisions (B)(2)(d)	119
and (e) of this section if the issuer's international	120
identification number or the processor's control number is	121
different for medical and pharmacy claims.	122

(D) Each multiple employer welfare arrangement described in	123
division (A) of this section shall annually file a certificate	124
with the superintendent of insurance certifying that it or any	125
person it contracts with to issue a standardized identification	126
card or electronic technology for submission and routing of	127
prescription drug claims complies with this section.	128

(E)(1) Except as provided in division (E)(2) of this section,	129
if there is a change in the information contained in the	130
standardized identification card or the electronic technology	131
issued to an individual, the multiple employer welfare arrangement	132
or person under contract with it to issue a standardized	133
identification card or an electronic technology shall issue a new	134
card or electronic technology to the individual.	135

(2) A multiple employer welfare arrangement or person under	136
contract with it is not required under division (E)(1) of this	137
section to issue a new card or electronic technology to an	138
individual more than once during a twelve-month period.	139

(F) Nothing in this section shall be construed as requiring a	140
multiple employer welfare arrangement to produce more than one	141
standardized identification card or one electronic technology for	142
use by individuals accessing health care benefits provided under a	143
multiple employer welfare arrangement.	144

Sec. 1751.14.  (A) Notwithstanding section 3901.71 of the	145
Revised Code, any policy, contract, or agreement for health care	146
services authorized by this chapter that is issued, delivered, or	147
renewed in this state and that provides that coverage of an	148
unmarried dependent child will terminate upon attainment of the	149
limiting age for dependent children specified in the policy,	150
contract, or agreement, shall also provide in substance both of	151
the following:	152

(1) Once an unmarried child has attained the limiting age for	153
dependent children, as provided in the policy, contract, or	154
agreement, upon the request of the subscriber, the health insuring	155
corporation shall offer to cover the unmarried child until the	156
child attains twenty-eighttwenty-six years of age if all of the	157
following are true:	158

(a) The child is the natural child, stepchild, or adopted	159
child of the subscriber.	160

(b) The child is a resident of this state or a full-time	161
student at an accredited public or private institution of higher	162
education.	163

(c) The child is not employed by an employer that offers any	164
health benefit plan under which the child is eligible for	165
coverage.	166

(d) The child is not eligible for coverage under the medicaid	167
program or the medicare program.	168

(2) That attainment of the limiting age for dependent	169
children shall not operate to terminate the coverage of a	170
dependent child if the child is and continues to be both of the	171
following:	172

(a) Incapable of self-sustaining employment by reason of	173
mental retardation or physical handicap;	174

(b) Primarily dependent upon the subscriber for support and	175
maintenance.	176

(B) Proof of incapacity and dependence for purposes of	177
division (A)(2) of this section shall be furnished to the health	178
insuring corporation within thirty-one days of the child's	179
attainment of the limiting age. Upon request, but not more	180
frequently than annually, the health insuring corporation may	181
require proof satisfactory to it of the continuance of such	182
incapacity and dependency.	183

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

184

(1) Require that any policy, contract, or agreement offer	185
coverage for dependent children or provide coverage for an	186
unmarried dependent child's children as dependents on the policy,	187
contract, or agreement;	188

(2) Require an employer to pay for any part of the premium	189
for an unmarried dependent child that has attained the limiting	190
age for dependents, as provided in the policy, contract, or	191
agreement;	192

(3) Require an employer to offer health insurance coverage to	193
the dependents of any employee.	194

(D) This section does not apply to any health insuring	195
corporation policy, contract, or agreement offering only	196
supplemental health care services or specialty health care	197
services.	198

(E) As used in this section, "health benefit plan" has the	199
same meaning as in section 3924.01 of the Revised Code and also	200
includes both of the following:	201

(1) A public employee benefit plan;

202

(2) A health benefit plan as regulated under the "Employee	203
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	204

Sec. 1751.69.  (A) As used in this section, "cost sharing"	205
means the cost to an individual insured under an individual or	206
group health insuring corporation policy, contract, or agreement	207
according to any coverage limit, copayment, coinsurance,	208
deductible, or other out-of-pocket expense requirements imposed by	209
the policy, contract, or agreement.	210

(B) Notwithstanding section 3901.71 of the Revised Code and	211
subject to division (D) of this section, no individual or group	212
health insuring corporation policy, contract, or agreement	213
providing basic health care services or prescription drug services	214
that is delivered, issued for delivery, or renewed in this state,	215
if the policy, contract, or agreement provides coverage for cancer	216
chemotherapy treatment, shall fail to comply with either of the	217
following:	218

(1) The policy, contract, or agreement shall not provide	219
coverage or impose cost sharing for a prescribed, orally	220
administered cancer medication on a less favorable basis than the	221
coverage it provides or cost sharing it imposes for intraveneously	222
administered or injected cancer medications.	223

(2) The policy, contract, or agreement shall not comply with	224
division (B)(1) of this section by imposing an increase in cost	225
sharing solely for orally administered, intravenously	226
administered, or injected cancer medications.	227

(C) Notwithstanding any provision of this section to the	228
contrary, an individual or group health insuring corporation	229
policy, contract, or agreement shall be deemed to be in compliance	230
with this section if the cost sharing imposed under such a policy,	231
contract, or agreement for orally administered cancer treatments	232
does not exceed one hundred dollars per prescription fill. The	233
cost sharing limit of one hundred dollars per prescription fill	234
shall apply to a high deductible plan, as defined in 26 U.S.C.	235
223, or a catastrophic plan, as defined in 42 U.S.C. 18022, only	236
after the deductible has been met.	237

(D) The prohibitions in division (B) of this section do not	238
preclude an individual or group health insuring corporation	239
policy, contract, or agreement from requiring an enrollee to	240
obtain prior authorization before orally administered cancer	241
medication is dispensed to the enrollee.	242

(E) A health insuring corporation that offers coverage for	243
basic health care services is not required to comply with division	244
(B) of this section if all of the following apply:	245

(1) The health insuring corporation submits documentation	246
certified by an independent member of the American academy of	247
actuaries to the superintendent of insurance showing that	248
compliance with division (B)(1) of this section for a period of at	249
least six months independently caused the health insuring	250
corporation's costs for claims and administrative expenses for the	251
coverage of basic health care services to increase by more than	252
one per cent per year.	253

(2) The health insuring corporation submits a signed letter	254
from an independent member of the American academy of actuaries to	255
the superintendent of insurance opining that the increase in costs	256
described in division (E)(1) of this section could reasonably	257
justify an increase of more than one per cent in the annual	258
premiums or rates charged by the health insuring corporation for	259
the coverage of basic health care services.	260

(3)(a) The superintendent of insurance makes the following	261
determinations from the documentation and opinion submitted	262
pursuant to divisions (E)(1) and (2) of this section:	263

(i) Compliance with division (B)(1) of this section for a	264
period of at least six months independently caused the health	265
insuring corporation's costs for claims and administrative	266
expenses for the coverage of basic health care services to	267
increase more than one per cent per year.	268

(ii) The increase in costs reasonably justifies an increase	269
of more than one per cent in the annual premiums or rates charged	270
by the health insuring corporation for the coverage of basic	271
health care services.	272

(b) Any determination made by the superintendent under	273
division (E)(3) of this section is subject to Chapter 119. of the	274
Revised Code.	275

Sec. 3702.40.  (A) As used in this section, "mammogram" and	276
"facility" have the same meanings as in section 263b(a) of the	277
"Mammography Quality Standards Act of 1992," 106 Stat. 3547	278
(1992), 42 U.S.C. 263b(a), as amended.	279

(B) As required by 21 C.F.R. 900.12(c)(2), a facility shall	280
send to each patient who has a mammogram at the facility a summary	281
of the written report containing the results of the patient's	282
mammogram. If, based on the breast imaging reporting and data	283
system established by the American college of radiology, the	284
patient's mammogram demonstrates that the patient has dense breast	285
tissue, the summary shall include the following statement:	286

"Your mammogram demonstrates that you have dense breast	287
tissue, which could hide abnormalities. Dense breast tissue, in	288
and of itself, is a relatively common condition. Therefore, this	289
information is not provided to cause undue concern; rather, it is	290
to raise your awareness and promote discussion with your health	291
care provider regarding the presence of dense breast tissue in	292
addition to other risk factors."	293

As required by 21 C.F.R. 900.12(c)(3), the facility shall	294
send to the patient's health care provider, if known, a copy of	295
the written report containing the results of the patient's	296
mammogram not later than thirty days after the mammogram was	297
performed.	298

(C) This section does not do either of the following:

299

(1) Create a new cause of action or substantive legal right	300
against a person, facility, or other entity.	301

(2) Create a standard of care, obligation, or duty for a	302
person, facility, or other entity that would provide the basis for	303
a cause of action or substantive legal right, other than the duty	304
to send the summary and written report described in division (B)	305
of this section.	306

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

307

(1)(a) "Administrative expense" means the amount resulting	308
from the following: the amount of premiums earned by the insurer	309
for sickness and accident insurance business plus the amount of	310
losses recovered from reinsurance coverage minus the sum of the	311
amount of claims for losses paid; the amount of losses incurred	312
but not reported; the amount incurred for state fees, federal and	313
state taxes, and reinsurance; and the incurred costs and expenses	314
related, either directly or indirectly, to the payment of	315
commissions, measures to control fraud, and managed care.	316

(b) "Administrative expense" does not include any amounts	317
collected, or administrative expenses incurred, by an insurer for	318
the administration of an employee health benefit plan subject to	319
regulation by the federal "Employee Retirement Income Security Act	320
of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended. "Amounts	321
collected or administrative expenses incurred" means the total	322
amount paid to an administrator for the administration and payment	323
of claims minus the sum of the amount of claims for losses paid	324
and the amount of losses incurred but not reported.	325

(2) "Insurer" means any insurance company authorized under	326
Title XXXIX of the Revised Code to do the business of sickness and	327
accident insurance in this state.	328

(3) "Sickness and accident insurance business" does not	329
include coverage provided by an insurer for specific diseases or	330
accidents only; any hospital indemnity, medicare supplement,	331
long-term care, disability income, one-time-limited-duration	332
policy of no longerthat is less than sixtwelve months, or other	333
policy that offers only supplemental benefits; or coverage	334
provided to individuals who are not residents of this state.	335

(4) "Individual business" includes both individual sickness	336
and accident insurance and sickness and accident insurance made	337
available by insurers in the individual market to individuals,	338
with or without family members or dependents, through group	339
policies issued to one or more associations or entities.	340

(B) Notwithstanding section 3941.14 of the Revised Code, each	341
insurer shall have aggregate administrative expenses of no more	342
than twenty per cent of the premium income of the insurer, based	343
on the premiums earned in that year on the sickness and accident	344
insurance business of the insurer.	345

(C)(1) Each insurer, on the first day of January or within	346
sixty days thereafter, shall annually prepare, under oath, and	347
deposit in the office of the superintendent of insurance a	348
statement of the aggregate administrative expenses of the insurer,	349
based on the premiums earned in the immediately preceding calendar	350
year on the sickness and accident insurance business of the	351
insurer. The statement shall itemize and separately detail all of	352
the following information with respect to the insurer's sickness	353
and accident insurance business:	354

(a) The amount of premiums earned by the insurer both before	355
and after any costs related to the insurer's purchase of	356
reinsurance coverage;	357

(b) The total amount of claims for losses paid by the insurer	358
both before and after any reimbursement from reinsurance coverage;	359

(c) The amount of any losses incurred by the insurer but not	360
reported by the insurer in the current or prior year;	361

(d) The amount of costs incurred by the insurer for state	362
fees and federal and state taxes;	363

(e) The amount of costs incurred by the insurer for	364
reinsurance coverage;	365

(f) The amount of costs incurred by the insurer that are	366
related to the insurer's payment of commissions;	367

(g) The amount of costs incurred by the insurer that are	368
related to the insurer's fraud prevention measures;	369

(h) The amount of costs incurred by the insurer that are	370
related to managed care; and	371

(i) Any other administrative expenses incurred by the	372
insurer.	373

(2) The statement also shall include all of the information	374
required under division (C)(1) of this section separately detailed	375
for the insurer's individual business, small group business, and	376
large group business.	377

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

378

(E) If the superintendent determines that an insurer has	379
violated this section, the superintendent, pursuant to an	380
adjudication conducted in accordance with Chapter 119. of the	381
Revised Code, may order the suspension of the insurer's license to	382
do the business of sickness and accident insurance in this state	383
until the superintendent is satisfied that the insurer is in	384
compliance with this section. If the insurer continues to do the	385
business of sickness and accident insurance in this state while	386
under the suspension order, the superintendent shall order the	387
insurer to pay one thousand dollars for each day of the violation.	388

(F) Any money collected by the superintendent under division	389
(E) of this section shall be deposited by the superintendent into	390
the state treasury to the credit of the department of insurance	391
operating fund.	392

(G) The statement of aggregate expenses filed pursuant to	393
this section separately detailing an insurer's individual, small	394
group, and large group business shall be considered work papers	395
resulting from the conduct of a market analysis of an entity	396
subject to examination by the superintendent under division (C) of	397
section 3901.48 of the Revised Code, except that the	398
superintendent may share aggregated market information that	399
identifies the premiums earned as reported under division	400
(C)(1)(a) of this section, the administrative expenses reported	401
under division (C)(1)(i) of this section, the amount of	402
commissions reported under division (C)(1)(f) of this section, the	403
amount of taxes paid as reported under division (C)(1)(d) of this	404
section, the total of the remaining benefit costs as reported	405
under divisions (C)(1)(b) and (c) of this section, and the amount	406
of fraud and managed care expenses reported under divisions	407
(C)(1)(g) and (h) of this section.	408

Sec. 3923.24.  (A) Notwithstanding section 3901.71 of the	409
Revised Code, every certificate furnished by an insurer in	410
connection with, or pursuant to any provision of, any group	411
sickness and accident insurance policy delivered, issued for	412
delivery, renewed, or used in this state on or after January 1,	413
1972, every policy of sickness and accident insurance delivered,	414
issued for delivery, renewed, or used in this state on or after	415
January 1, 1972, and every multiple employer welfare arrangement	416
offering an insurance program, which provides that coverage of an	417
unmarried dependent child of a parent or legal guardian will	418
terminate upon attainment of the limiting age for dependent	419
children specified in the contract shall also provide in substance	420
both of the following:	421

(1) Once an unmarried child has attained the limiting age for	422
dependent children, as provided in the policy, upon the request of	423
the insured, the insurer shall offer to cover the unmarried child	424
until the child attains twenty-eighttwenty-six years of age if	425
all of the following are true:	426

(a) The child is the natural child, stepchild, or adopted	427
child of the insured.	428

(b) The child is a resident of this state or a full-time	429
student at an accredited public or private institution of higher	430
education.	431

(c) The child is not employed by an employer that offers any	432
health benefit plan under which the child is eligible for	433
coverage.	434

(d) The child is not eligible for the medicaid program or the	435
medicare program.	436

(2) That attainment of the limiting age for dependent	437
children shall not operate to terminate the coverage of a	438
dependent child if the child is and continues to be both of the	439
following:	440

(a) Incapable of self-sustaining employment by reason of	441
mental retardation or physical handicap;	442

(b) Primarily dependent upon the policyholder or certificate	443
holder for support and maintenance.	444

(B) Proof of such incapacity and dependence for purposes of	445
division (A)(2) of this section shall be furnished by the	446
policyholder or by the certificate holder to the insurer within	447
thirty-one days of the child's attainment of the limiting age.	448
Upon request, but not more frequently than annually after the	449
two-year period following the child's attainment of the limiting	450
age, the insurer may require proof satisfactory to it of the	451
continuance of such incapacity and dependency.	452

(C) Nothing in this section shall require an insurer to cover	453
a dependent child who is mentally retarded or physically	454
handicapped if the contract is underwritten on evidence of	455
insurability based on health factors set forth in the application,	456
or if such dependent child does not satisfy the conditions of the	457
contract as to any requirement for evidence of insurability or	458
other provision of the contract, satisfaction of which is required	459
for coverage thereunder to take effect. In any such case, the	460
terms of the contract shall apply with regard to the coverage or	461
exclusion of the dependent from such coverage. Nothing in this	462
section shall apply to accidental death or dismemberment benefits	463
provided by any such policy of sickness and accident insurance.	464

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

465

(1) Require that any policy offer coverage for dependent	466
children or provide coverage for an unmarried dependent child's	467
children as dependents on the policy;	468

(2) Require an employer to pay for any part of the premium	469
for an unmarried dependent child that has attained the limiting	470
age for dependents, as provided in the policy;	471

(3) Require an employer to offer health insurance coverage to	472
the dependents of any employee.	473

(E) This section does not apply to any policies or	474
certificates covering only accident, credit, dental, disability	475
income, long-term care, hospital indemnity, medicare supplement,	476
specified disease, or vision care; coverage under a	477
one-time-limited-duration policy of not longerthat is less than	478
sixtwelve months; coverage issued as a supplement to liability	479
insurance; insurance arising out of a workers' compensation or	480
similar law; automobile medical-payment insurance; or insurance	481
under which benefits are payable with or without regard to fault	482
and that is statutorily required to be contained in any liability	483
insurance policy or equivalent self-insurance.	484

(F) As used in this section, "health benefit plan" has the	485
same meaning as in section 3924.01 of the Revised Code and also	486
includes both of the following:	487

(1) A public employee benefit plan;

488

(2) A health benefit plan as regulated under the "Employee	489
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	490

Sec. 3923.241. (A) Notwithstanding section 3901.71 of the	491
Revised Code, any public employee benefit plan that provides that	492
coverage of an unmarried dependent child will terminate upon	493
attainment of the limiting age for dependent children specified in	494
the plan shall also provide in substance both of the following:	495

(1) Once an unmarried child has attained the limiting age for	496
dependent children, as provided in the plan, upon the request of	497
the employee, the public employee benefit plan shall offer to	498
cover the unmarried child until the child attains twenty-eight	499
twenty-six years of age if all of the following are true:	500

(a) The child is the natural child, stepchild, or adopted	501
child of the employee.	502

(b) The child is a resident of this state or a full-time	503
student at an accredited public or private institution of higher	504
education.	505

(c) The child is not employed by an employer that offers any	506
health benefit plan under which the child is eligible for	507
coverage.	508

(d) The child is not eligible for the medicaid program or the	509
medicare program.	510

(2) That attainment of the limiting age for dependent	511
children shall not operate to terminate the coverage of a	512
dependent child if the child is and continues to be both of the	513
following:	514

(a) Incapable of self-sustaining employment by reason of	515
mental retardation or physical handicap;	516

(b) Primarily dependent upon the plan member for support and	517
maintenance.	518

(B) Proof of incapacity and dependence for purposes of	519
division (A)(2) of this section shall be furnished to the public	520
employee benefit plan within thirty-one days of the child's	521
attainment of the limiting age. Upon request, but not more	522
frequently than annually, the public employee benefit plan may	523
require proof satisfactory to it of the continuance of such	524
incapacity and dependency.	525

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

526

(1) Require that any public employee benefit plan offer	527
coverage for dependent children or provide coverage for an	528
unmarried dependent child's children as dependents on the public	529
employee benefit plan;	530

(2) Require an employer to pay for any part of the premium	531
for an unmarried dependent child that has attained the limiting	532
age for dependents, as provided in the plan;	533

(3) Require an employer to offer health insurance coverage to	534
the dependents of any employee.	535

(D) This section does not apply to any public employee	536
benefit plan covering only accident, credit, dental, disability	537
income, long-term care, hospital indemnity, medicare supplement,	538
specified disease, or vision care; coverage under a	539
one-time-limited-duration policy of not longerthat is less than	540
sixtwelve months; coverage issued as a supplement to liability	541
insurance; insurance arising out of a workers' compensation or	542
similar law; automobile medical-payment insurance; or insurance	543
under which benefits are payable with or without regard to fault	544
and which is statutorily required to be contained in any liability	545
insurance policy or equivalent self-insurance.	546

(E) As used in this section, "health benefit plan" has the	547
same meaning as in section 3924.01 of the Revised Code and also	548
includes both of the following:	549

(1) A public employee benefit plan;

550

(2) A health benefit plan as regulated under the "Employee	551
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	552

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

553

(1) "Biologically based mental illness" means schizophrenia,	554
schizoaffective disorder, major depressive disorder, bipolar	555
disorder, paranoia and other psychotic disorders,	556
obsessive-compulsive disorder, and panic disorder, as these terms	557
are defined in the most recent edition of the diagnostic and	558
statistical manual of mental disorders published by the American	559
psychiatric association.	560

(2) "Policy of sickness and accident insurance" has the same	561
meaning as in section 3923.01 of the Revised Code, but excludes	562
any hospital indemnity, medicare supplement, long-term care,	563
disability income, one-time-limited-duration policy of not longer	564
that is less than sixtwelve months, supplemental benefit, or	565
other policy that provides coverage for specific diseases or	566
accidents only; any policy that provides coverage for workers'	567
compensation claims compensable pursuant to Chapters 4121. and	568
4123. of the Revised Code; and any policy that provides coverage	569
to medicaid recipients.	570

(B) Notwithstanding section 3901.71 of the Revised Code, and	571
subject to division (E) of this section, every policy of sickness	572
and accident insurance shall provide benefits for the diagnosis	573
and treatment of biologically based mental illnesses on the same	574
terms and conditions as, and shall provide benefits no less	575
extensive than, those provided under the policy of sickness and	576
accident insurance for the treatment and diagnosis of all other	577
physical diseases and disorders, if both of the following apply:	578

(1) The biologically based mental illness is clinically	579
diagnosed by a physician authorized under Chapter 4731. of the	580
Revised Code to practice medicine and surgery or osteopathic	581
medicine and surgery; a psychologist licensed under Chapter 4732.	582
of the Revised Code; a licensed professional clinical counselor,	583
licensed professional counselor, independent social worker, or	584
independent marriage and family therapist licensed under Chapter	585
4757. of the Revised Code; or a clinical nurse specialist or	586
certified nurse practitioner licensed under Chapter 4723. of the	587
Revised Code whose nursing specialty is mental health.	588

(2) The prescribed treatment is not experimental or	589
investigational, having proven its clinical effectiveness in	590
accordance with generally accepted medical standards.	591

(C) Division (B) of this section applies to all coverages and	592
terms and conditions of the policy of sickness and accident	593
insurance, including, but not limited to, coverage of inpatient	594
hospital services, outpatient services, and medication; maximum	595
lifetime benefits; copayments; and individual and family	596
deductibles.	597

(D) Nothing in this section shall be construed as prohibiting	598
a sickness and accident insurance company from taking any of the	599
following actions:	600

(1) Negotiating separately with mental health care providers	601
with regard to reimbursement rates and the delivery of health care	602
services;	603

(2) Offering policies that provide benefits solely for the	604
diagnosis and treatment of biologically based mental illnesses;	605

(3) Managing the provision of benefits for the diagnosis or	606
treatment of biologically based mental illnesses through the use	607
of pre-admission screening, by requiring beneficiaries to obtain	608
authorization prior to treatment, or through the use of any other	609
mechanism designed to limit coverage to that treatment determined	610
to be necessary;	611

(4) Enforcing the terms and conditions of a policy of	612
sickness and accident insurance.	613

(E) An insurer that offers any policy of sickness and	614
accident insurance is not required to provide benefits for the	615
diagnosis and treatment of biologically based mental illnesses	616
pursuant to division (B) of this section if all of the following	617
apply:	618

(1) The insurer submits documentation certified by an	619
independent member of the American academy of actuaries to the	620
superintendent of insurance showing that incurred claims for	621
diagnostic and treatment services for biologically based mental	622
illnesses for a period of at least six months independently caused	623
the insurer's costs for claims and administrative expenses for the	624
coverage of all other physical diseases and disorders to increase	625
by more than one per cent per year.	626

(2) The insurer submits a signed letter from an independent	627
member of the American academy of actuaries to the superintendent	628
of insurance opining that the increase described in division	629
(E)(1) of this section could reasonably justify an increase of	630
more than one per cent in the annual premiums or rates charged by	631
the insurer for the coverage of all other physical diseases and	632
disorders.	633

(3) The superintendent of insurance makes the following	634
determinations from the documentation and opinion submitted	635
pursuant to divisions (E)(1) and (2) of this section:	636

(a) Incurred claims for diagnostic and treatment services for	637
biologically based mental illnesses for a period of at least six	638
months independently caused the insurer's costs for claims and	639
administrative expenses for the coverage of all other physical	640
diseases and disorders to increase by more than one per cent per	641
year.	642

(b) The increase in costs reasonably justifies an increase of	643
more than one per cent in the annual premiums or rates charged by	644
the insurer for the coverage of all other physical diseases and	645
disorders.	646

Any determination made by the superintendent under this	647
division is subject to Chapter 119. of the Revised Code.	648

Sec. 3923.57.  Notwithstanding any provision of this chapter,	649
every individual policy of sickness and accident insurance that is	650
delivered, issued for delivery, or renewed in this state is	651
subject to the following conditions, as applicable:	652

(A) Pre-existing conditions provisions shall not exclude or	653
limit coverage for a period beyond twelve months following the	654
policyholder's effective date of coverage and may only relate to	655
conditions during the six months immediately preceding the	656
effective date of coverage.	657

(B) In determining whether a pre-existing conditions	658
provision applies to a policyholder or dependent, each policy	659
shall credit the time the policyholder or dependent was covered	660
under a previous policy, contract, or plan if the previous	661
coverage was continuous to a date not more than thirty days prior	662
to the effective date of the new coverage, exclusive of any	663
applicable service waiting period under the policy.	664

(C)(1) Except as otherwise provided in division (C) of this	665
section, an insurer that provides an individual sickness and	666
accident insurance policy to an individual shall renew or continue	667
in force such coverage at the option of the individual.	668

(2) An insurer may nonrenew or discontinue coverage of an	669
individual in the individual market based only on one or more of	670
the following reasons:	671

(a) The individual failed to pay premiums or contributions in	672
accordance with the terms of the policy or the insurer has not	673
received timely premium payments.	674

(b) The individual performed an act or practice that	675
constitutes fraud or made an intentional misrepresentation of	676
material fact under the terms of the policy.	677

(c) The insurer is ceasing to offer coverage in the	678
individual market in accordance with division (D) of this section	679
and the applicable laws of this state.	680

(d) If the insurer offers coverage in the market through a	681
network plan, the individual no longer resides, lives, or works in	682
the service area, or in an area for which the insurer is	683
authorized to do business; provided, however, that such coverage	684
is terminated uniformly without regard to any health	685
status-related factor of covered individuals.	686

(e) If the coverage is made available in the individual	687
market only through one or more bona fide associations, the	688
membership of the individual in the association, on the basis of	689
which the coverage is provided, ceases; provided, however, that	690
such coverage is terminated under division (C)(2)(e) of this	691
section uniformly without regard to any health status-related	692
factor of covered individuals.	693

An insurer offering coverage to individuals solely through	694
membership in a bona fide association shall not be deemed, by	695
virtue of that offering, to be in the individual market for	696
purposes of sections 3923.58 and 3923.581 of the Revised Code.	697
Such an insurer shall not be required to accept applicants for	698
coverage in the individual market pursuant to sections 3923.58 and	699
3923.581 of the Revised Code unless the insurer also offers	700
coverage to individuals other than through bona fide associations.	701

(3) An insurer may cancel or decide not to renew the coverage	702
of a dependent of an individual if the dependent has performed an	703
act or practice that constitutes fraud or made an intentional	704
misrepresentation of material fact under the terms of the coverage	705
and if the cancellation or nonrenewal is not based, either	706
directly or indirectly, on any health status-related factor in	707
relation to the dependent.	708

(D)(1) If an insurer decides to discontinue offering a	709
particular type of health insurance coverage offered in the	710
individual market, coverage of such type may be discontinued by	711
the insurer if the insurer does all of the following:	712

(a) Provides notice to each individual provided coverage of	713
this type in such market of the discontinuation at least ninety	714
days prior to the date of the discontinuation of the coverage;	715

(b) Offers to each individual provided coverage of this type	716
in such market, the option to purchase any other individual health	717
insurance coverage currently being offered by the insurer for	718
individuals in that market;	719

(c) In exercising the option to discontinue coverage of this	720
type and in offering the option of coverage under division	721
(D)(1)(b) of this section, acts uniformly without regard to any	722
health status-related factor of covered individuals or of	723
individuals who may become eligible for such coverage.	724

(2) If an insurer elects to discontinue offering all health	725
insurance coverage in the individual market in this state, health	726
insurance coverage may be discontinued by the insurer only if both	727
of the following apply:	728

(a) The insurer provides notice to the department of	729
insurance and to each individual of the discontinuation at least	730
one hundred eighty days prior to the date of the expiration of the	731
coverage.	732

(b) All health insurance delivered or issued for delivery in	733
this state in such market is discontinued and coverage under that	734
health insurance in that market is not renewed.	735

(3) In the event of a discontinuation under division (D)(2)	736
of this section in the individual market, the insurer shall not	737
provide for the issuance of any health insurance coverage in the	738
market and this state during the five-year period beginning on the	739
date of the discontinuation of the last health insurance coverage	740
not so renewed.	741

(E) Notwithstanding divisions (C) and (D) of this section, an	742
insurer may, at the time of coverage renewal, modify the health	743
insurance coverage for a policy form offered to individuals in the	744
individual market if the modification is consistent with the law	745
of this state and effective on a uniform basis among all	746
individuals with that policy form.	747

(F) Such policies are subject to sections 2743 and 2747 of	748
the "Health Insurance Portability and Accountability Act of 1996,"	749
Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg-43 and	750
300gg-47, as amended.	751

(G) Sections 3924.031 and 3924.032 of the Revised Code shall	752
apply to sickness and accident insurance policies offered in the	753
individual market in the same manner as they apply to health	754
benefit plans offered in the small employer market.	755

In accordance with 45 C.F.R. 148.102, divisions (C) to (G) of	756
this section also apply to all group sickness and accident	757
insurance policies that are not sold in connection with an	758
employment-related group health plan and that provide more than	759
short-term, limited duration coverage.	760

In applying divisions (C) to (G) of this section with respect	761
to health insurance coverage that is made available by an insurer	762
in the individual market to individuals only through one or more	763
associations, the term "individual" includes the association of	764
which the individual is a member.	765

For purposes of this section, any policy issued pursuant to	766
division (C) of section 3923.13 of the Revised Code in connection	767
with a public or private college or university student health	768
insurance program is considered to be issued to a bona fide	769
association.	770

As used in this section, "bona fide association" has the same	771
meaning as in section 3924.03 of the Revised Code, and "health	772
status-related factor" and "network plan" have the same meanings	773
as in section 3924.031 of the Revised Code.	774

This section does not apply to any policy that provides	775
coverage for specific diseases or accidents only, or to any	776
hospital indemnity, medicare supplement, long-term care,	777
disability income, one-time-limited-duration policy of no longer	778
that is less than sixtwelve months, or other policy that offers	779
only supplemental benefits.	780

Sec. 3923.58.  (A) As used in sections 3923.58 and 3923.59 of	781
the Revised Code:	782

(1) "Base rate" means, as to any health benefit plan that is	783
issued by a carrier in the individual market, the lowest premium	784
rate for new or existing business prescribed by the carrier for	785
the same or similar coverage under a plan or arrangement covering	786
any individual with similar case characteristics.	787

(2) "Carrier," "health benefit plan," and "MEWA" have the	788
same meanings as in section 3924.01 of the Revised Code.	789

(3) "Network plan" means a health benefit plan of a carrier	790
under which the financing and delivery of medical care, including	791
items and services paid for as medical care, are provided, in	792
whole or in part, through a defined set of providers under	793
contract with the carrier.	794

(4) "Ohio health care basic and standard plans" means those	795
plans established under section 3924.10 of the Revised Code.	796

(5) "Pre-existing conditions provision" means a policy	797
provision that excludes or limits coverage for charges or expenses	798
incurred during a specified period following the insured's	799
effective date of coverage as to a condition which, during a	800
specified period immediately preceding the effective date of	801
coverage, had manifested itself in such a manner as would cause an	802
ordinarily prudent person to seek medical advice, diagnosis, care,	803
or treatment or for which medical advice, diagnosis, care, or	804
treatment was recommended or received, or a pregnancy existing on	805
the effective date of coverage.	806

(B) Beginning in January of each year, carriers in the	807
business of issuing health benefit plans to individuals and	808
nonemployer groups, except individual health benefit plans issued	809
pursuant to sections 1751.16 and 3923.122 of the Revised Code,	810
shall accept applicants for open enrollment coverage, as set forth	811
in this division, in the order in which they apply for coverage	812
and subject to the limitation set forth in division (G) of this	813
section. Carriers shall accept for coverage pursuant to this	814
section individuals to whom both of the following conditions	815
apply:	816

(1) The individual is not applying for coverage as an	817
employee of an employer, as a member of an association, or as a	818
member of any other group.	819

(2) The individual is not covered, and is not eligible for	820
coverage, under any other private or public health benefits	821
arrangement, including the medicare program established under	822
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42	823
U.S.C.A. 301, as amended, or any other act of congress or law of	824
this or any other state of the United States that provides	825
benefits comparable to the benefits provided under this section,	826
any medicare supplement policy, or any continuation of coverage	827
policy under state or federal law.	828

(C) A carrier shall offer to any individual accepted under	829
this section the Ohio health care basic and standard plans or	830
health benefit plans that are substantially similar to the Ohio	831
health care basic and standard plans in benefit plan design and	832
scope of covered services.	833

A carrier may offer other health benefit plans in addition	834
to, but not in lieu of, the plans required to be offered under	835
this division. A basic health benefit plan shall provide, at a	836
minimum, the coverage provided by the Ohio health care basic plan	837
or any health benefit plan that is substantially similar to the	838
Ohio health care basic plan in benefit plan design and scope of	839
covered services. A standard health benefit plan shall provide, at	840
a minimum, the coverage provided by the Ohio health care standard	841
plan or any health benefit plan that is substantially similar to	842
the Ohio health care standard plan in benefit plan design and	843
scope of covered services.	844

For purposes of this division, the superintendent of	845
insurance shall determine whether a health benefit plan is	846
substantially similar to the Ohio health care basic and standard	847
plans in benefit plan design and scope of covered services.	848

(D)(1) Health benefit plans issued under this section may	849
establish pre-existing conditions provisions that exclude or limit	850
coverage for a period of up to twelve months following the	851
individual's effective date of coverage and that may relate only	852
to conditions during the six months immediately preceding the	853
effective date of coverage. A health insuring corporation may	854
apply a pre-existing condition provision for any basic health care	855
service related to a transplant of a body organ if the transplant	856
occurs within one year after the effective date of an enrollee's	857
coverage under this section except with respect to a newly born	858
child who meets the requirements for coverage under section	859
1751.61 of the Revised Code.	860

(2) In determining whether a pre-existing conditions	861
provision applies to an insured or dependent, each policy shall	862
credit the time the insured or dependent was covered under a	863
previous policy, contract, or plan if the previous coverage was	864
continuous to a date not more than sixty-three days prior to the	865
effective date of the new coverage, exclusive of any applicable	866
service waiting period under the policy.	867

(E) Premiums charged to individuals under this section may	868
not exceed the amounts specified below:	869

(1) For calendar years 2010 and 2011, an amount that is two	870
times the base rate for coverage offered to any other individual	871
to which the carrier is currently accepting new business, and for	872
which similar copayments and deductibles are applied;	873

(2) For calendar year 2012 and every year thereafter, an	874
amount that is one and one-half times the base rate for coverage	875
offered to any other individual to which the carrier is currently	876
accepting new business and for which similar copayments and	877
deductibles are applied, unless the superintendent of insurance	878
determines that the amendments by this act to this section and	879
section 3923.581 of the Revised Code, have resulted in the	880
market-wide average medical loss ratio for coverage sold to	881
individual insureds and nonemployer group insureds in this state,	882
including open enrollment insureds, to increase by more than five	883
and one quarter percentage points during calendar year 2010. If	884
the superintendent makes that determination, the premium limit	885
established by division (E)(1) of this section shall remain in	886
effect. The superintendent's determination shall be supported by a	887
signed letter from a member of the American academy of actuaries.	888

(F) In offering health benefit plans under this section, a	889
carrier may require the purchase of health benefit plans that	890
condition the reimbursement of health services upon the use of a	891
specific network of providers.	892

(G)(1) A carrier shall not be required to accept new	893
applicants under this section if the total number of the carrier's	894
current insureds with open enrollment coverage issued under this	895
section calculated as of the immediately preceding thirty-first	896
day of December and excluding the carrier's medicare supplement	897
policies and conversion or continuation of coverage policies under	898
state or federal law and any policies described in division (L) of	899
this section meets the following limits:	900

(a) For calendar years 2010 and 2011, four per cent of the	901
carrier's total number of individual or nonemployer group insureds	902
in this state;	903

(b) For calendar year 2012 and every year thereafter, eight	904
per cent of the carrier's total number of insured individuals and	905
nonemployer group insureds in this state, unless the	906
superintendent of insurance determines that the amendments by this	907
act to this section and section 3923.581 of the Revised Code, have	908
resulted in the market-wide average medical loss ratio for	909
coverage sold to individual insureds and nonemployer group	910
insureds in this state, including open enrollment insureds, to	911
increase by more than five and one quarter percentage points	912
during calendar year 2010. If the superintendent makes that	913
determination, the enrollment limit established by division	914
(G)(1)(a) of this section shall remain in effect. The	915
superintendent's determination shall be supported by a signed	916
letter from a member of the American academy of actuaries.	917

(2) An officer of the carrier shall certify to the department	918
of insurance when it has met the enrollment limit set forth in	919
division (G)(1) of this section. Upon providing such	920
certification, the carrier shall be relieved of its open	921
enrollment requirement under this section as long as the carrier	922
continues to meet the open enrollment limit. If the total number	923
of the carrier's current insureds with open enrollment coverage	924
issued under this section falls below the enrollment limit, the	925
carrier shall accept new applicants. A carrier may establish a	926
waiting list if the carrier has met the open enrollment limit and	927
shall notify the superintendent if the carrier has a waiting list	928
in effect.	929

(H) A carrier shall not be required to accept under this	930
section applicants who, at the time of enrollment, are confined to	931
a health care facility because of chronic illness, permanent	932
injury, or other infirmity that would cause economic impairment to	933
the carrier if the applicants were accepted. A carrier shall not	934
be required to make the effective date of benefits for individuals	935
accepted under this section earlier than ninety days after the	936
date of acceptance, except that when the individual had prior	937
coverage with a health benefit plan that was terminated by a	938
carrier because the carrier exited the market and the individual	939
was accepted for open enrollment under this section within	940
sixty-three days of that termination, the effective date of	941
benefits shall be the date of enrollment.	942

(I) The requirements of this section do not apply to any	943
carrier that is currently in a state of supervision, insolvency,	944
or liquidation. If a carrier demonstrates to the satisfaction of	945
the superintendent that the requirements of this section would	946
place the carrier in a state of supervision, insolvency, or	947
liquidation, or would otherwise jeopardize the carrier's economic	948
viability overall or in the individual market, the superintendent	949
may waive or modify the requirements of division (B) or (G) of	950
this section. The actions of the superintendent under this	951
division shall be effective for a period of not more than one	952
year. At the expiration of such time, a new showing of need for a	953
waiver or modification by the carrier shall be made before a new	954
waiver or modification is issued or imposed.	955

(J) No hospital, health care facility, or health care	956
practitioner, and no person who employs any health care	957
practitioner, shall balance bill any individual or dependent of an	958
individual for any health care supplies or services provided to	959
the individual or dependent who is insured under a policy issued	960
under this section. The hospital, health care facility, or health	961
care practitioner, or any person that employs the health care	962
practitioner, shall accept payments made to it by the carrier	963
under the terms of the policy or contract insuring or covering	964
such individual as payment in full for such health care supplies	965
or services.	966

As used in this division, "hospital" has the same meaning as	967
in section 3727.01 of the Revised Code; "health care practitioner"	968
has the same meaning as in section 4769.01 of the Revised Code;	969
and "balance bill" means charging or collecting an amount in	970
excess of the amount reimbursable or payable under the policy or	971
health care service contract issued to an individual under this	972
section for such health care supply or service. "Balance bill"	973
does not include charging for or collecting copayments or	974
deductibles required by the policy or contract.	975

(K) A carrier may pay an agent a commission in the amount of	976
not more than five per cent of the premium charged for initial	977
placement or for otherwise securing the issuance of a policy or	978
contract issued to an individual under this section, and not more	979
than four per cent of the premium charged for the renewal of such	980
a policy or contract. The superintendent may adopt, in accordance	981
with Chapter 119. of the Revised Code, such rules as are necessary	982
to enforce this division.	983

(L) This section does not apply to any policy that provides	984
coverage for specific diseases or accidents only, or to any	985
hospital indemnity, medicare supplement, long-term care,	986
disability income, one-time-limited-duration policy of no longer	987
that is less than sixtwelve months, or other policy that offers	988
only supplemental benefits.	989

(M) If a carrier offers a health benefit plan in the	990
individual market through a network plan, the carrier may do both	991
of the following:	992

(1) Limit the individuals that may apply for such coverage to	993
those who live, work, or reside in the service area of the network	994
plan;	995

(2) Within the service area of the network plan, deny the	996
coverage to individuals if the carrier has demonstrated both of	997
the following to the superintendent:	998

(a) The carrier will not have the capacity to deliver	999
services adequately to any additional individuals because of the	1000
carrier's obligations to existing group contract holders and	1001
individuals.	1002

(b) The carrier is applying division (M)(2) of this section	1003
uniformly to all individuals without regard to any health	1004
status-related factors of those individuals.	1005

(N) A carrier that, pursuant to division (M)(2) of this	1006
section, denies coverage to an individual in the service area of a	1007
network plan, shall not offer coverage in the individual market	1008
within that service area for at least one hundred eighty days	1009
after the date the carrier denies the coverage.	1010

Sec. 3923.601. (A)(1) This section applies to both of the	1011
following:	1012

(a) A sickness and accident insurer that issues or requires	1013
the use of a standardized identification card or an electronic	1014
technology for submission and routing of prescription drug claims	1015
pursuant to a policy, contract, or agreement for health care	1016
services;	1017

(b) A person that a sickness and accident insurer contracts	1018
with to issue a standardized identification card or an electronic	1019
technology described in division (A)(1)(a) of this section.	1020

(2) Notwithstanding division (A)(1) of this section, this	1021
section does not apply to the issuance or required use of a	1022
standardized identification card or an electronic technology for	1023
the submission and routing of prescription drug claims in	1024
connection with any of the following:	1025

(a) Any individual or group policy of sickness and accident	1026
insurance covering only accident, credit, dental, disability	1027
income, long-term care, hospital indemnity, medicare supplement,	1028
medicare, tricare, specified disease, or vision care; coverage	1029
under a one-time-limited-duration policy of not longerthat is	1030
less than sixtwelve months; coverage issued as a supplement to	1031
liability insurance; insurance arising out of workers'	1032
compensation or similar law; automobile medical payment insurance;	1033
or insurance under which benefits are payable with or without	1034
regard to fault and which is statutorily required to be contained	1035
in any liability insurance policy or equivalent self-insurance.	1036

(b) Coverage provided under the medicaid program.

1037

(c) Coverage provided under an employer's self-insurance plan	1038
or by any of its administrators, as defined in section 3959.01 of	1039
the Revised Code, to the extent that federal law supersedes,	1040
preempts, prohibits, or otherwise precludes the application of	1041
this section to the plan and its administrators.	1042

(B) A standardized identification card or an electronic	1043
technology issued or required to be used as provided in division	1044
(A)(1) of this section shall contain uniform prescription drug	1045
information in accordance with either division (B)(1) or (2) of	1046
this section.	1047

(1) The standardized identification card or the electronic	1048
technology shall be in a format and contain information fields	1049
approved by the national council for prescription drug programs or	1050
a successor organization, as specified in the council's or	1051
successor organization's pharmacy identification card	1052
implementation guide in effect on the first day of October most	1053
immediately preceding the issuance or required use of the	1054
standardized identification card or the electronic technology.	1055

(2) If the insurer or person under contract with the insurer	1056
to issue a standardized identification card or an electronic	1057
technology requires the information for the submission and routing	1058
of a claim, the standardized identification card or the electronic	1059
technology shall contain any of the following information:	1060

(a) The insurer's name;

1061

(b) The insured's name, group number, and identification	1062
number;	1063

(c) A telephone number to inquire about pharmacy-related	1064
issues;	1065

(d) The issuer's international identification number, labeled	1066
as "ANSI BIN" or "RxBIN";	1067

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

1068

(f) The insured's pharmacy benefits group number if different	1069
from the insured's medical group number, labeled as "RxGrp."	1070

(C) If the standardized identification card or the electronic	1071
technology issued or required to be used as provided in division	1072
(A)(1) of this section is also used for submission and routing of	1073
nonpharmacy claims, the designation "Rx" is required to be	1074
included as part of the labels identified in divisions (B)(2)(d)	1075
and (e) of this section if the issuer's international	1076
identification number or the processor's control number is	1077
different for medical and pharmacy claims.	1078

(D) Each sickness and accident insurer described in division	1079
(A) of this section shall annually file a certificate with the	1080
superintendent of insurance certifying that it or any person it	1081
contracts with to issue a standardized identification card or	1082
electronic technology for submission and routing of prescription	1083
drug claims complies with this section.	1084

(E)(1) Except as provided in division (E)(2) of this section,	1085
if there is a change in the information contained in the	1086
standardized identification card or the electronic technology	1087
issued to an insured, the insurer or person under contract with	1088
the insurer to issue a standardized identification card or an	1089
electronic technology shall issue a new card or electronic	1090
technology to the insured.	1091

(2) An insurer or person under contract with the insurer is	1092
not required under division (E)(1) of this section to issue a new	1093
card or electronic technology to an insured more than once during	1094
a twelve-month period.	1095

(F) Nothing in this section shall be construed as requiring	1096
an insurer to produce more than one standardized identification	1097
card or one electronic technology for use by insureds accessing	1098
health care benefits provided under a policy of sickness and	1099
accident insurance.	1100

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

1101

(1) "Emergency medical condition" means a medical condition	1102
that manifests itself by such acute symptoms of sufficient	1103
severity, including severe pain, that a prudent layperson with	1104
average knowledge of health and medicine could reasonably expect	1105
the absence of immediate medical attention to result in any of the	1106
following:	1107

(a) Placing the health of the individual or, with respect to	1108
a pregnant woman, the health of the woman or her unborn child, in	1109
serious jeopardy;	1110

(b) Serious impairment to bodily functions;

1111

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

1112

(2) "Emergency services" means the following:

1113

(a) A medical screening examination, as required by federal	1114
law, that is within the capability of the emergency department of	1115
a hospital, including ancillary services routinely available to	1116
the emergency department, to evaluate an emergency medical	1117
condition;	1118

(b) Such further medical examination and treatment that are	1119
required by federal law to stabilize an emergency medical	1120
condition and are within the capabilities of the staff and	1121
facilities available at the hospital, including any trauma and	1122
burn center of the hospital.	1123

(B) Every individual or group policy of sickness and accident	1124
insurance that provides hospital, surgical, or medical expense	1125
coverage shall cover emergency services without regard to the day	1126
or time the emergency services are rendered or to whether the	1127
policyholder, the hospital's emergency department where the	1128
services are rendered, or an emergency physician treating the	1129
policyholder, obtained prior authorization for the emergency	1130
services.	1131

(C) Every individual policy or certificate furnished by an	1132
insurer in connection with any sickness and accident insurance	1133
policy shall provide information regarding the following:	1134

(1) The scope of coverage for emergency services;

1135

(2) The appropriate use of emergency services, including the	1136
use of the 9-1-1 system and any other telephone access systems	1137
utilized to access prehospital emergency services;	1138

(3) Any copayments for emergency services.

1139

(D) This section does not apply to any individual or group	1140
policy of sickness and accident insurance covering only accident,	1141
credit, dental, disability income, long-term care, hospital	1142
indemnity, medicare supplement, medicare, tricare, specified	1143
disease, or vision care; coverage under a one-time limited	1144
duration policy of no longerthat is less than sixtwelve months;	1145
coverage issued as a supplement to liability insurance; insurance	1146
arising out of workers' compensation or similar law; automobile	1147
medical payment insurance; or insurance under which benefits are	1148
payable with or without regard to fault and which is statutorily	1149
required to be contained in any liability insurance policy or	1150
equivalent self-insurance.	1151

Sec. 3923.83. (A)(1) This section applies to both of the	1152
following:	1153

(a) A public employee benefit plan that issues or requires	1154
the use of a standardized identification card or an electronic	1155
technology for submission and routing of prescription drug claims	1156
pursuant to a policy, contract, or agreement for health care	1157
services;	1158

(b) A person or entity that a public employee benefit plan	1159
contracts with to issue a standardized identification card or an	1160
electronic technology described in division (A)(1)(a) of this	1161
section.	1162

(2) Notwithstanding division (A)(1) of this section, this	1163
section does not apply to the issuance or required use of a	1164
standardized identification card or an electronic technology for	1165
the submission and routing of prescription drug claims in	1166
connection with either of the following:	1167

(a) Any individual or group policy of insurance covering only	1168
accident, credit, dental, disability income, long-term care,	1169
hospital indemnity, medicare supplement, medicare, tricare,	1170
specified disease, or vision care; coverage under a	1171
one-time-limited-duration policy of not longerthat is less than	1172
sixtwelve months; coverage issued as a supplement to liability	1173
insurance; insurance arising out of workers' compensation or	1174
similar law; automobile medical payment insurance; or insurance	1175
under which benefits are payable with or without regard to fault	1176
and which is statutorily required to be contained in any liability	1177
insurance policy or equivalent self-insurance.	1178

(b) Coverage provided under the medicaid program.

1179

(B) A standardized identification card or an electronic	1180
technology issued or required to be used as provided in division	1181
(A)(1) of this section shall contain uniform prescription drug	1182
information in accordance with either division (B)(1) or (2) of	1183
this section.	1184

(1) The standardized identification card or the electronic	1185
technology shall be in a format and contain information fields	1186
approved by the national council for prescription drug programs or	1187
a successor organization, as specified in the council's or	1188
successor organization's pharmacy identification card	1189
implementation guide in effect on the first day of October most	1190
immediately preceding the issuance or required use of the	1191
standardized identification card or the electronic technology.	1192

(2) If the public employee benefit plan or person under	1193
contract with the plan to issue a standardized identification card	1194
or an electronic technology requires the information for the	1195
submission and routing of a claim, the standardized identification	1196
card or the electronic technology shall contain any of the	1197
following information:	1198

(a) The plan's name;

1199

(b) The insured's name, group number, and identification	1200
number;	1201

(c) A telephone number to inquire about pharmacy-related	1202
issues;	1203

(d) The issuer's international identification number, labeled	1204
as "ANSI BIN" or "RxBIN";	1205

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

1206

(f) The insured's pharmacy benefits group number if different	1207
from the insured's medical group number, labeled as "RxGrp."	1208

(C) If the standardized identification card or the electronic	1209
technology issued or required to be used as provided in division	1210
(A)(1) of this section is also used for submission and routing of	1211
nonpharmacy claims, the designation "Rx" is required to be	1212
included as part of the labels identified in divisions (B)(2)(d)	1213
and (e) of this section if the issuer's international	1214
identification number or the processor's control number is	1215
different for medical and pharmacy claims.	1216

(D)(1) Except as provided in division (D)(2) of this section,	1217
if there is a change in the information contained in the	1218
standardized identification card or the electronic technology	1219
issued to an insured, the public employee benefit plan or person	1220
under contract with the plan to issue a standardized	1221
identification card or electronic technology shall issue a new	1222
card or electronic technology to the insured.	1223

(2) A public employee benefit plan or person under contract	1224
with the plan is not required under division (D)(1) of this	1225
section to issue a new card or electronic technology to an insured	1226
more than once during a twelve-month period.	1227

(E) Nothing in this section shall be construed as requiring a	1228
public employee benefit plan to produce more than one standardized	1229
identification card or one electronic technology for use by	1230
insureds accessing health care benefits provided under a health	1231
benefit plan.	1232

Sec. 3923.85.  (A) As used in this section, "cost sharing"	1233
means the cost to an individual insured under an individual or	1234
group policy of sickness and accident insurance or a public	1235
employee benefit plan according to any coverage limit, copayment,	1236
coinsurance, deductible, or other out-of-pocket expense	1237
requirements imposed by the policy or plan.	1238

(B) Notwithstanding section 3901.71 of the Revised Code and	1239
subject to division (D) of this section, no individual or group	1240
policy of sickness and accident insurance that is delivered,	1241
issued for delivery, or renewed in this state and no public	1242
employee benefit plan that is established or modified in this	1243
state shall fail to comply with either of the following:	1244

(1) The policy or plan shall not provide coverage or impose	1245
cost sharing for a prescribed, orally administered cancer	1246
medication on a less favorable basis than the coverage it provides	1247
or cost sharing it imposes for intraveneously administered or	1248
injected cancer medications.	1249

(2) The policy or plan shall not comply with division (B)(1)	1250
of this section by imposing an increase in cost sharing solely for	1251
orally administered, intravenously administered, or injected	1252
cancer medications.	1253

(C) Notwithstanding any provision of this section to the	1254
contrary, a policy or plan shall be deemed to be in compliance	1255
with this section if the cost sharing imposed under such a policy	1256
or plan for orally administered cancer treatments does not exceed	1257
one hundred dollars per prescription fill. The cost sharing limit	1258
of one hundred dollars per prescription fill shall apply to a high	1259
deductible plan, as defined in 26 U.S.C. 223, or a catastrophic	1260
plan, as defined in 42 U.S.C. 18022, only after the deductible has	1261
been met.	1262

(D)(1) The prohibitions in division (B) of this section do	1263
not preclude an individual or group policy of sickness and	1264
accident insurance or public employee benefit plan from requiring	1265
an insured or plan member to obtain prior authorization before	1266
orally administered cancer medication is dispensed to the insured	1267
or plan member.	1268

(2) Division (B) of this section does not apply to the offer	1269
or renewal of any individual or group policy of sickness and	1270
accident insurance that provides coverage for specific diseases or	1271
accidents only, or to any hospital indemnity, medicare supplement,	1272
disability income, or other policy that offers only supplemental	1273
benefits.	1274

(E) An insurer that offers any sickness and accident	1275
insurance or any public employee benefit plan that offers coverage	1276
for basic health care services is not required to comply with	1277
division (B) of this section if all of the following apply:	1278

(1) The insurer or plan submits documentation certified by an	1279
independent member of the American academy of actuaries to the	1280
superintendent of insurance showing that compliance with division	1281
(B)(1) of this section for a period of at least six months	1282
independently caused the insurer or plan's costs for claims and	1283
administrative expenses for the coverage of basic health care	1284
services to increase by more than one per cent per year.	1285

(2) The insurer or plan submits a signed letter from an	1286
independent member of the American academy of actuaries to the	1287
superintendent of insurance opining that the increase in costs	1288
described in division (E)(1) of this section could reasonably	1289
justify an increase of more than one per cent in the annual	1290
premiums or rates charged by the insurer or plan for the coverage	1291
of basic health care services.	1292

(3)(a) The superintendent of insurance makes the following	1293
determinations from the documentation and opinion submitted	1294
pursuant to divisions (E)(1) and (2) of this section:	1295

(i) Compliance with division (B)(1) of this section for a	1296
period of at least six months independently caused the insurer or	1297
plan's costs for claims and administrative expenses for the	1298
coverage of basic health care services to increase more than one	1299
per cent per year.	1300

(ii) The increase in costs reasonably justifies an increase	1301
of more than one per cent in the annual premiums or rates charged	1302
by the insurer or plan for the coverage of basic health care	1303
services.	1304

(b) Any determination made by the superintendent under	1305
division (E)(3) of this section is subject to Chapter 119. of the	1306
Revised Code.	1307

Sec. 3924.01.  As used in sections 3924.01 to 3924.14 of the	1308
Revised Code:	1309

(A) "Actuarial certification" means a written statement	1310
prepared by a member of the American academy of actuaries, or by	1311
any other person acceptable to the superintendent of insurance,	1312
that states that, based upon the person's examination, a carrier	1313
offering health benefit plans to small employers is in compliance	1314
with sections 3924.01 to 3924.14 of the Revised Code. "Actuarial	1315
certification" shall include a review of the appropriate records	1316
of, and the actuarial assumptions and methods used by, the carrier	1317
relative to establishing premium rates for the health benefit	1318
plans.	1319

(B) "Adjusted average market premium price" means the average	1320
market premium price as determined by the board of directors of	1321
the Ohio health reinsurance program either on the basis of the	1322
arithmetic mean of all carriers' premium rates for an OHC plan	1323
sold to groups with similar case characteristics by all carriers	1324
selling OHC plans in the state, or on any other equitable basis	1325
determined by the board.	1326

(C) "Base premium rate" means, as to any health benefit plan	1327
that is issued by a carrier and that covers at least two but no	1328
more than fifty employees of a small employer, the lowest premium	1329
rate for a new or existing business prescribed by the carrier for	1330
the same or similar coverage under a plan or arrangement covering	1331
any small employer with similar case characteristics.	1332

(D) "Carrier" means any sickness and accident insurance	1333
company or health insuring corporation authorized to issue health	1334
benefit plans in this state or a MEWA. A sickness and accident	1335
insurance company that owns or operates a health insuring	1336
corporation, either as a separate corporation or as a line of	1337
business, shall be considered as a separate carrier from that	1338
health insuring corporation for purposes of sections 3924.01 to	1339
3924.14 of the Revised Code.	1340

(E) "Case characteristics" means, with respect to a small	1341
employer, the geographic area in which the employees work; the age	1342
and sex of the individual employees and their dependents; the	1343
appropriate industry classification as determined by the carrier;	1344
the number of employees and dependents; and such other objective	1345
criteria as may be established by the carrier. "Case	1346
characteristics" does not include claims experience, health	1347
status, or duration of coverage from the date of issue.	1348

(F) "Dependent" means the spouse or child of an eligible	1349
employee, subject to applicable terms of the health benefits plan	1350
covering the employee.	1351

(G) "Eligible employee" means an employee who works a normal	1352
work week of twenty-fivethirty or more hours. "Eligible employee"	1353
does not include a temporary or substitute employee, or a seasonal	1354
employee who works only part of the calendar year on the basis of	1355
natural or suitable times or circumstances.	1356

(H) "Health benefit plan" means any hospital or medical	1357
expense policy or certificate or any health plan provided by a	1358
carrier, that is delivered, issued for delivery, renewed, or used	1359
in this state on or after the date occurring six months after	1360
November 24, 1995. "Health benefit plan" does not include policies	1361
covering only accident, credit, dental, disability income,	1362
long-term care, hospital indemnity, medicare supplement, specified	1363
disease, or vision care; coverage under a	1364
one-time-limited-duration policy of no longerthat is less than	1365
sixtwelve months; coverage issued as a supplement to liability	1366
insurance; insurance arising out of a workers' compensation or	1367
similar law; automobile medical-payment insurance; or insurance	1368
under which benefits are payable with or without regard to fault	1369
and which is statutorily required to be contained in any liability	1370
insurance policy or equivalent self-insurance.	1371

(I) "Late enrollee" means an eligible employee or dependent	1372
who enrolls in a small employer's health benefit plan other than	1373
during the first period in which the employee or dependent is	1374
eligible to enroll under the plan or during a special enrollment	1375
period described in section 2701(f) of the "Health Insurance	1376
Portability and Accountability Act of 1996," Pub. L. No. 104-191,	1377
110 Stat. 1955, 42 U.S.C.A. 300gg, as amended.	1378

(J) "MEWA" means any "multiple employer welfare arrangement"	1379
as defined in section 3 of the "Federal Employee Retirement Income	1380
Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended,	1381
except for any arrangement which is fully insured as defined in	1382
division (b)(6)(D) of section 514 of that act.	1383

(K) "Midpoint rate" means, for small employers with similar	1384
case characteristics and plan designs and as determined by the	1385
applicable carrier for a rating period, the arithmetic average of	1386
the applicable base premium rate and the corresponding highest	1387
premium rate.	1388

(L) "Pre-existing conditions provision" means a policy	1389
provision that excludes or limits coverage for charges or expenses	1390
incurred during a specified period following the insured's	1391
enrollment date as to a condition for which medical advice,	1392
diagnosis, care, or treatment was recommended or received during a	1393
specified period immediately preceding the enrollment date.	1394
Genetic information shall not be treated as such a condition in	1395
the absence of a diagnosis of the condition related to such	1396
information.	1397

For purposes of this division, "enrollment date" means, with	1398
respect to an individual covered under a group health benefit	1399
plan, the date of enrollment of the individual in the plan or, if	1400
earlier, the first day of the waiting period for such enrollment.	1401

(M) "Service waiting period" means the period of time after	1402
employment begins before an employee is eligible to be covered for	1403
benefits under the terms of any applicable health benefit plan	1404
offered by the small employer.	1405

(N)(1) "Small employer" means, in connection with a group	1406
health benefit plan and with respect to a calendar year and a plan	1407
year, an employer who employed an average of at least two but no	1408
more than fifty eligible employees on business days during the	1409
preceding calendar year and who employs at least two employees on	1410
the first day of the plan year.	1411

(2) For purposes of division (N)(1) of this section, all	1412
persons treated as a single employer under subsection (b), (c),	1413
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	1414
100 Stat. 2085, 26 U.S.C.A. 1, as amended, shall be considered one	1415
employer. In the case of an employer that was not in existence	1416
throughout the preceding calendar year, the determination of	1417
whether the employer is a small or large employer shall be based	1418
on the average number of eligible employees that it is reasonably	1419
expected the employer will employ on business days in the current	1420
calendar year. Any reference in division (N) of this section to an	1421
"employer" includes any predecessor of the employer. Except as	1422
otherwise specifically provided, provisions of sections 3924.01 to	1423
3924.14 of the Revised Code that apply to a small employer that	1424
has a health benefit plan shall continue to apply until the plan	1425
anniversary following the date the employer no longer meets the	1426
requirements of this division.	1427

(O) "OHC plan" means an Ohio health care plan, which is the	1428
basic, standard, or carrier reimbursement plan for small employers	1429
and individuals established in accordance with section 3924.10 of	1430
the Revised Code.	1431

Sec. 4729.291.  (A) When a licensed health professional	1432
authorized to prescribe drugs personally furnishes drugs to a	1433
patient pursuant to division (B) of section 4729.29 of the Revised	1434
Code, the prescriber shall ensure that the drugs are labeled and	1435
packaged in accordance with state and federal drug laws and any	1436
rules and regulations adopted pursuant to those laws. Records of	1437
purchase and disposition of all drugs personally furnished to	1438
patients shall be maintained by the prescriber in accordance with	1439
state and federal drug statutes and any rules adopted pursuant to	1440
those statutes.	1441

(B) When personally furnishing to a patient RU-486	1442
(mifepristone), a prescriber is subject to section 2919.123 of the	1443
Revised Code. A prescription for RU-486 (mifepristone) shall be in	1444
writing and in accordance with section 2919.123 of the Revised	1445
Code.	1446

(C)(1) Except as provided in division (D) of this section, a	1447
prescriber mayshall not do either of the following:	1448

(a) In any thirty-day period, personally furnish to or for	1449
patients, taken as a whole, controlled substances in an amount	1450
that exceeds a total of two thousand five hundred dosage units;	1451

(b) In any seventy-two-hour period, personally furnish to or	1452
for a patient an amount of a controlled substance that exceeds the	1453
amount necessary for the patient's use in a seventy-two-hour	1454
period.	1455

(2) The state board of pharmacy may impose a fine of not more	1456
than five thousand dollars on a prescriber who fails to comply	1457
with the limits established under division (C)(1) of this section.	1458
A separate fine may be imposed for each instance of failing to	1459
comply with the limits. In imposing the fine, the board's actions	1460
shall be taken in accordance with Chapter 119. of the Revised	1461
Code.	1462

(D)(1) None of the following shall be counted in determining	1463
whether the amounts specified in division (C)(1) of this section	1464
have been exceeded:	1465

(a) Methadone provided to patients for the purpose of	1466
treating drug dependence or addiction, if the prescriber meets the	1467
conditions specified in 21 C.F.R. 1306.07;	1468

(b) Buprenorphine provided to patients for the purpose of	1469
treating drug dependence or addiction, if the prescriber is exempt	1470
from separate registration with the United States drug enforcement	1471
administrationas part of an opioid treatment program that is the	1472
subject of a current, valid certification from the substance abuse	1473
and mental health services administration of the United States	1474
department of health and human services pursuant to 2142 C.F.R.	1475
1301.288.11 and distributes both buprenorphine and methadone;	1476

(c) Controlled substances provided to research subjects by a	1477
facility conducting clinical research in studies approved by a	1478
hospital-based institutional review board or an institutional	1479
review board accredited by the association for the accreditation	1480
of human research protection programs.	1481

(2) Division (C)(1) of this section does not apply to a	1482
prescriber who is a veterinarian.	1483

Sec. 4729.541.  (A) Except as provided in divisions (B) and	1484
(C) of this section, a business entity described in division	1485
(B)(1)(j) or (k) of section 4729.51 of the Revised Code may	1486
possess, have custody or control of, and distribute the dangerous	1487
drugs in category I, category II, and category III, as defined in	1488
section 4729.54 of the Revised Code, without holding a terminal	1489
distributor of dangerous drugs license issued under that section.	1490

(B) If a business entity described in division (B)(1)(j) or	1491
(k) of section 4729.51 of the Revised Code is a pain management	1492
clinic or is operating a pain management clinic, the entity shall	1493
hold a license as a terminal distributor of dangerous drugs with a	1494
pain management clinic classification issued under section	1495
4729.552 of the Revised Code.	1496

(C) Beginning April 1, 2015, a business entity described in	1497
division (B)(1)(j) or (k) of section 4729.51 of the Revised Code	1498
shall hold a license as a terminal distributor of dangerous drugs	1499
in order to possess, have custody or control of, and distribute	1500
dangerouseither of the following:	1501

(1) Dangerous drugs that are compounded or used for the	1502
purpose of compounding;	1503

(2) Controlled substances containing buprenorphine that are	1504
used for the purpose of treating drug dependence or addiction.	1505

Sec. 4731.056. (A) As used in this section:

1506

(1) "Controlled substance," "schedule III," "schedule IV,"	1507
and "schedule V" have the same meanings as in section 3719.01 of	1508
the Revised Code.	1509

(2) "Physician" means an individual authorized by this	1510
chapter to practice medicine and surgery or osteopathic medicine	1511
and surgery.	1512

(B) The state medical board shall adopt rules in accordance	1513
with Chapter 119. of the Revised Code that establish standards and	1514
procedures to be followed by physicians in the use of controlled	1515
substances in schedule III, IV, or V to treat opioid dependence or	1516
addiction. The board may limit the application of the rules to	1517
treatment provided through an office-based practice or other	1518
practice type or location specified by the board.	1519

Section 2.  That existing sections 1739.061, 1751.14,	1520
1751.69, 3923.022, 3923.24, 3923.241, 3923.281, 3923.57, 3923.58,	1521
3923.601, 3923.65, 3923.83, 3923.85, 3924.01, 4729.291, and	1522
4729.541 of the Revised Code are hereby repealed.	1523

Section 3. Section 1751.14 and division (G) of section	1524
3924.01 of the Revised Code, as amended by this act, apply only to	1525
policies, contracts, and agreements that are delivered, issued for	1526
delivery, or renewed in this state on or after January 1, 2016.	1527
Division (A)(1) of section 3923.24 and division (A)(1) of section	1528
3923.241 of the Revised Code, as amended by this act, apply only	1529
to policies of sickness and accident insurance delivered, issued	1530
for delivery, or renewed in this state and public employee benefit	1531
plans or multiple employer welfare arrangement contracts and	1532
certificates that are established or modified in this state on or	1533
after January 1, 2016.	1534

Section 4. The General Assembly declares that the amendments	1535
made to section 3923.58 of the Revised Code by this act are not to	1536
supersede the suspension of the operation of this section enacted	1537
by Section 3 of Sub. S.B. 9 of the 130th General Assembly. Rather,	1538
it is the intent of the General Assembly to ensure consistency in	1539
Ohio Insurance Law should this suspension be nullified.	1540