|
|
| To amend section 1739.05 and to enact sections | 1 |
| 1751.76, 3923.71, and 3923.74 of the Revised Code | 2 |
| to prohibit health insurers from denying payment | 3 |
| for a service during or after the performance of | 4 |
| the service if the insurer provided prior written | 5 |
| authorization for the service. | 6 |
| Section 1. That section 1739.05 be amended and sections | 7 |
| 1751.76, 3923.71, and 3923.74 of the Revised Code be enacted to | 8 |
| read as follows: | 9 |
| Sec. 1739.05. (A) A multiple employer welfare arrangement | 10 |
| that is created pursuant to sections 1739.01 to 1739.22 of the | 11 |
| Revised Code and that operates a group self-insurance program may | 12 |
| be established only if any of the following applies: | 13 |
| (1) The arrangement has and maintains a minimum enrollment of | 14 |
| three hundred employees of two or more employers. | 15 |
| (2) The arrangement has and maintains a minimum enrollment of | 16 |
| three hundred self-employed individuals. | 17 |
| (3) The arrangement has and maintains a minimum enrollment of | 18 |
| three hundred employees or self-employed individuals in any | 19 |
| combination of divisions (A)(1) and (2) of this section. | 20 |
| (B) A multiple employer welfare arrangement that is created | 21 |
| pursuant to sections 1739.01 to 1739.22 of the Revised Code and | 22 |
| that operates a group self-insurance program shall comply with all | 23 |
| laws applicable to self-funded programs in this state, including | 24 |
| sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381 | 25 |
| to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14, | 26 |
| 3923.24, 3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, | 27 |
| 3923.74, 3923.80, 3924.031, 3924.032, and 3924.27 of the Revised | 28 |
| Code. | 29 |
| (C) A multiple employer welfare arrangement created pursuant | 30 |
| to sections 1739.01 to 1739.22 of the Revised Code shall solicit | 31 |
| enrollments only through agents or solicitors licensed pursuant to | 32 |
| Chapter 3905. of the Revised Code to sell or solicit sickness and | 33 |
| accident insurance. | 34 |
| (D) A multiple employer welfare arrangement created pursuant | 35 |
| to sections 1739.01 to 1739.22 of the Revised Code shall provide | 36 |
| benefits only to individuals who are members, employees of | 37 |
| members, or the dependents of members or employees, or are | 38 |
| eligible for continuation of coverage under section 1751.53 or | 39 |
| 3923.38 of the Revised Code or under Title X of the "Consolidated | 40 |
| Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29 | 41 |
| U.S.C.A. 1161, as amended. | 42 |
| Sec. 1751.76. No health insuring corporation that agrees in | 43 |
| writing to provide coverage for the performance of a service prior | 44 |
| to the performance of the service shall deny payment for the | 45 |
| service during or after the performance of the service unless the | 46 |
| health insuring corporation's written agreement to provide | 47 |
| coverage for the service was based upon inaccurate information | 48 |
| provided to the health insuring corporation by the enrollee or | 49 |
| health care provider. | 50 |
| Sec. 3923.71. No sickness and accident insurer that agrees | 51 |
| in writing to provide coverage for the performance of a service | 52 |
| prior to the performance of the service shall deny payment for the | 53 |
| service during or after the performance of the service unless the | 54 |
| insurer's written agreement to provide coverage for the service | 55 |
| was based upon inaccurate information provided to the insurer by | 56 |
| the insured or the health care provider. | 57 |
| Sec. 3923.74. No public employee benefit plan that agrees in | 58 |
| writing to provide coverage for the performance of a service prior | 59 |
| to the performance of the service shall deny payment for the | 60 |
| service during or after the performance of the service unless the | 61 |
| public employee benefit plan's written agreement to provide | 62 |
| coverage for the service was based upon inaccurate information | 63 |
| provided to the public employee benefit plan by the plan member, | 64 |
| covered dependent, or health care provider. | 65 |
| Section 2. That existing section 1739.05 of the Revised Code | 66 |
| is hereby repealed. | 67 |