S. B. No. 88 As Introduced

As Introduced

130th General Assembly

Regular Session

2013-2014

S. B. No. 88

Senator Skindell

Cosponsors: Senators Turner, Tavares

A BILL

To amend sections 124.14 and 3924.01 and to enact

sections 3965.01 to 3965.14 of the Revised Code to

establish the Ohio Health Benefit Exchange Agency

and to establish the Ohio Health Benefit Exchange

Program consisting of an exchange for individual

coverage and a Small Business Health Options

Program.

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

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

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

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

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

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

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

(B) Division (A) of this section and sections 124.15 and	77
124.152 of the Revised Code do not apply to the following persons,	78
positions, offices, and employments:	79

(1) Elected officials;

(2) Legislative employees, employees of the legislative	81
service commission, employees in the office of the governor,	82
employees who are in the unclassified civil service and exempt	83
from collective bargaining coverage in the office of the secretary	84
of state, auditor of state, treasurer of state, and attorney	85
general, and employees of the supreme court;	86

(3) Any position for which the authority to determine	87
compensation is given by law to another individual or entity;	88

(4) Employees of the bureau of workers' compensation whose	89
compensation the administrator of workers' compensation	90
establishes under division (B) of section 4121.121 of the Revised	91
Code;	92

(5) Employees of the Ohio health benefit exchange program	93
whose compensation the board of the Ohio health benefit exchange	94
agency establishes under division (H) of section 3965.03 of the	95
Revised Code.	96

(C) The director may employ a consulting agency to aid and	97
assist the director in carrying out this section.	98

(D)(1) When the director proposes to modify a classification	99
or the assignment of classes to appropriate pay ranges, the	100
director shall send written notice of the proposed rule to the	101
appointing authorities of the affected employees thirty days	102
before a hearing on the proposed rule. The appointing authorities	103
shall notify the affected employees regarding the proposed rule.	104
The director also shall send those appointing authorities notice	105
of any final rule that is adopted within ten days after adoption.	106

(2) When the director proposes to reclassify any employee in	107
the service of the state so that the employee is adversely	108
affected, the director shall give to the employee affected and to	109
the employee's appointing authority a written notice setting forth	110
the proposed new classification, pay range, and salary. Upon the	111
request of any classified employee in the service of the state who	112
is not serving in a probationary period, the director shall	113
perform a job audit to review the classification of the employee's	114
position to determine whether the position is properly classified.	115
The director shall give to the employee affected and to the	116
employee's appointing authority a written notice of the director's	117
determination whether or not to reclassify the position or to	118
reassign the employee to another classification. An employee or	119
appointing authority desiring a hearing shall file a written	120
request for the hearing with the state personnel board of review	121
within thirty days after receiving the notice. The board shall set	122
the matter for a hearing and notify the employee and appointing	123
authority of the time and place of the hearing. The employee, the	124
appointing authority, or any authorized representative of the	125
employee who wishes to submit facts for the consideration of the	126
board shall be afforded reasonable opportunity to do so. After the	127
hearing, the board shall consider anew the reclassification and	128
may order the reclassification of the employee and require the	129
director to assign the employee to such appropriate classification	130
as the facts and evidence warrant. As provided in division (A)(1)	131
of section 124.03 of the Revised Code, the board may determine the	132
most appropriate classification for the position of any employee	133
coming before the board, with or without a job audit. The board	134
shall disallow any reclassification or reassignment classification	135
of any employee when it finds that changes have been made in the	136
duties and responsibilities of any particular employee for	137
political, religious, or other unjust reasons.	138

(E)(1) Employees of each county department of job and family	139
services shall be paid a salary or wage established by the board	140
of county commissioners. The provisions of section 124.18 of the	141
Revised Code concerning the standard work week apply to employees	142
of county departments of job and family services. A board of	143
county commissioners may do either of the following:	144

(a) Notwithstanding any other section of the Revised Code,	145
supplement the sick leave, vacation leave, personal leave, and	146
other benefits of any employee of the county department of job and	147
family services of that county, if the employee is eligible for	148
the supplement under a written policy providing for the	149
supplement;	150

(b) Notwithstanding any other section of the Revised Code,	151
establish alternative schedules of sick leave, vacation leave,	152
personal leave, or other benefits for employees not inconsistent	153
with the provisions of a collective bargaining agreement covering	154
the affected employees.	155

(2) Division (E)(1) of this section does not apply to	156
employees for whom the state employment relations board	157
establishes appropriate bargaining units pursuant to section	158
4117.06 of the Revised Code, except in either of the following	159
situations:	160

(a) The employees for whom the state employment relations	161
board establishes appropriate bargaining units elect no	162
representative in a board-conducted representation election.	163

(b) After the state employment relations board establishes	164
appropriate bargaining units for such employees, all employee	165
organizations withdraw from a representation election.	166

(F)(1) Notwithstanding any contrary provision of sections	167
124.01 to 124.64 of the Revised Code, the board of trustees of	168
each state university or college, as defined in section 3345.12 of	169
the Revised Code, shall carry out all matters of governance	170
involving the officers and employees of the university or college,	171
including, but not limited to, the powers, duties, and functions	172
of the department of administrative services and the director of	173
administrative services specified in this chapter. Officers and	174
employees of a state university or college shall have the right of	175
appeal to the state personnel board of review as provided in this	176
chapter.	177

(2) Each board of trustees shall adopt rules under section	178
111.15 of the Revised Code to carry out the matters of governance	179
described in division (F)(1) of this section. Until the board of	180
trustees adopts those rules, a state university or college shall	181
continue to operate pursuant to the applicable rules adopted by	182
the director of administrative services under this chapter.	183

(G)(1) Each board of county commissioners may, by a	184
resolution adopted by a majority of its members, establish a	185
county personnel department to exercise the powers, duties, and	186
functions specified in division (G) of this section. As used in	187
division (G) of this section, "county personnel department" means	188
a county personnel department established by a board of county	189
commissioners under division (G)(1) of this section.	190

(2)(a) Each board of county commissioners, by a resolution	191
adopted by a majority of its members, may designate the county	192
personnel department of the county to exercise the powers, duties,	193
and functions specified in sections 124.01 to 124.64 and Chapter	194
325. of the Revised Code with regard to employees in the service	195
of the county, except for the powers and duties of the state	196
personnel board of review, which powers and duties shall not be	197
construed as having been modified or diminished in any manner by	198
division (G)(2) of this section, with respect to the employees for	199
whom the board of county commissioners is the appointing authority	200
or co-appointing authority.	201

(b) Nothing in division (G)(2) of this section shall be	202
construed to limit the right of any employee who possesses the	203
right of appeal to the state personnel board of review to continue	204
to possess that right of appeal.	205

(c) Any board of county commissioners that has established a	206
county personnel department may contract with the department of	207
administrative services, in accordance with division (H) of this	208
section, another political subdivision, or an appropriate public	209
or private entity to provide competitive testing services or other	210
appropriate services.	211

(3) After the county personnel department of a county has	212
been established as described in division (G)(2) of this section,	213
any elected official, board, agency, or other appointing authority	214
of that county, upon written notification to the county personnel	215
department, may elect to use the services and facilities of the	216
county personnel department. Upon receipt of the notification by	217
the county personnel department, the county personnel department	218
shall exercise the powers, duties, and functions as described in	219
division (G)(2) of this section with respect to the employees of	220
that elected official, board, agency, or other appointing	221
authority.	222

(4) Each board of county commissioners, by a resolution	223
adopted by a majority of its members, may disband the county	224
personnel department.	225

(5) Any elected official, board, agency, or appointing	226
authority of a county may end its involvement with a county	227
personnel department upon actual receipt by the department of a	228
certified copy of the notification that contains the decision to	229
no longer participate.	230

(6) A county personnel department, in carrying out its	231
duties, shall adhere to merit system principles with regard to	232
employees of county departments of job and family services, child	233
support enforcement agencies, and public child welfare agencies so	234
that there is no threatened loss of federal funding for these	235
agencies, and the county is financially liable to the state for	236
any loss of federal funds due to the action or inaction of the	237
county personnel department.	238

(H) County agencies may contract with the department of	239
administrative services for any human resources services,	240
including, but not limited to, establishment and modification of	241
job classification plans, competitive testing services, and	242
periodic audits and reviews of the county's uniform application of	243
the powers, duties, and functions specified in sections 124.01 to	244
124.64 and Chapter 325. of the Revised Code with regard to	245
employees in the service of the county. Nothing in this division	246
modifies the powers and duties of the state personnel board of	247
review with respect to employees in the service of the county.	248
Nothing in this division limits the right of any employee who	249
possesses the right of appeal to the state personnel board of	250
review to continue to possess that right of appeal.	251

(I) The director of administrative services shall establish	252
the rate and method of compensation for all employees who are paid	253
directly by warrant of the director of budget and management and	254
who are serving in positions that the director of administrative	255
services has determined impracticable to include in the state job	256
classification plan. This division does not apply to elected	257
officials, legislative employees, employees of the legislative	258
service commission, employees who are in the unclassified civil	259
service and exempt from collective bargaining coverage in the	260
office of the secretary of state, auditor of state, treasurer of	261
state, and attorney general, employees of the courts, employees of	262
the bureau of workers' compensation whose compensation the	263
administrator of workers' compensation establishes under division	264
(B) of section 4121.121 of the Revised Code, or employees of an	265
appointing authority authorized by law to fix the compensation of	266
those employees.	267

(J) The director of administrative services shall set the	268
rate of compensation for all intermittent, seasonal, temporary,	269
emergency, and casual employees in the service of the state who	270
are not considered public employees under section 4117.01 of the	271
Revised Code. Those employees are not entitled to receive employee	272
benefits. This rate of compensation shall be equitable in terms of	273
the rate of employees serving in the same or similar	274
classifications. This division does not apply to elected	275
officials, legislative employees, employees of the legislative	276
service commission, employees who are in the unclassified civil	277
service and exempt from collective bargaining coverage in the	278
office of the secretary of state, auditor of state, treasurer of	279
state, and attorney general, employees of the courts, employees of	280
the bureau of workers' compensation whose compensation the	281
administrator establishes under division (B) of section 4121.121	282
of the Revised Code, or employees of an appointing authority	283
authorized by law to fix the compensation of those employees.	284

Sec. 3924.01. As used in sections 3924.01 to 3924.14 of the	285
Revised Code:	286

(A) "Actuarial certification" means a written statement	287
prepared by a member of the American academy of actuaries, or by	288
any other person acceptable to the superintendent of insurance,	289
that states that, based upon the person's examination, a carrier	290
offering health benefit plans to small employers is in compliance	291
with sections 3924.01 to 3924.14 of the Revised Code. "Actuarial	292
certification" shall include a review of the appropriate records	293
of, and the actuarial assumptions and methods used by, the carrier	294
relative to establishing premium rates for the health benefit	295
plans.	296

(B) "Adjusted average market premium price" means the average	297
market premium price as determined by the board of directors of	298
the Ohio health reinsurance program either on the basis of the	299
arithmetic mean of all carriers' premium rates for an OHC plan	300
sold to groups with similar case characteristics by all carriers	301
selling OHC plans in the state, or on any other equitable basis	302
determined by the board.	303

(C) "Base premium rate" means, as to any health benefit plan	304
that is issued by a carrier and that covers at least two but no	305
more than fifty employees of a small employer, the lowest premium	306
rate for a new or existing business prescribed by the carrier for	307
the same or similar coverage under a plan or arrangement covering	308
any small employer with similar case characteristics.	309

(D) "Carrier" means any sickness and accident insurance	310
company or health insuring corporation authorized to issue health	311
benefit plans in this state or a MEWA. A sickness and accident	312
insurance company that owns or operates a health insuring	313
corporation, either as a separate corporation or as a line of	314
business, shall be considered as a separate carrier from that	315
health insuring corporation for purposes of sections 3924.01 to	316
3924.14 of the Revised Code.	317

(E) "Case characteristics" means, with respect to a small	318
employer, the geographic area in which the employees work; the age	319
and sex of the individual employees and their dependents; the	320
appropriate industry classification as determined by the carrier;	321
the number of employees and dependents; and such other objective	322
criteria as may be established by the carrier. "Case	323
characteristics" does not include claims experience, health	324
status, or duration of coverage from the date of issue.	325

(F) "Dependent" means the spouse or child of an eligible	326
employee, subject to applicable terms of the health benefits plan	327
covering the employee.	328

(G) "Eligible employee" means an employee who works a normal	329
work week of twenty-five or more hours. "Eligible employee" does	330
not include a temporary or substitute employee, or a seasonal	331
employee who works only part of the calendar year on the basis of	332
natural or suitable times or circumstances.	333

(H) "Health benefit plan" means any hospital or medical	334
expense policy or certificate or any health plan provided by a	335
carrier, that is delivered, issued for delivery, renewed, or used	336
in this state on or after the date occurring six months after	337
November 24, 1995. "Health benefit plan" does not include policies	338
covering only accident, credit, dental, disability income,	339
long-term care, hospital indemnity, medicare supplement, specified	340
disease, or vision care; coverage under a	341
one-time-limited-duration policy of no longer than six months;	342
coverage issued as a supplement to liability insurance; insurance	343
arising out of a workers' compensation or similar law; automobile	344
medical-payment insurance; or insurance under which benefits are	345
payable with or without regard to fault and which is statutorily	346
required to be contained in any liability insurance policy or	347
equivalent self-insurance.	348

(I) "Late enrollee" means an eligible employee or dependent	349
who enrolls in a small employer's health benefit plan other than	350
during the first period in which the employee or dependent is	351
eligible to enroll under the plan or during a special enrollment	352
period described in section 2701(f) of the "Health Insurance	353
Portability and Accountability Act of 1996," Pub. L. No. 104-191,	354
110 Stat. 1955, 42 U.S.C.A. 300gg, as amended.	355

(J) "MEWA" means any "multiple employer welfare arrangement"	356
as defined in section 3 of the "Federal Employee Retirement Income	357
Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended,	358
except for any arrangement which is fully insured as defined in	359
division (b)(6)(D) of section 514 of that act.	360

(K) "Midpoint rate" means, for small employers with similar	361
case characteristics and plan designs and as determined by the	362
applicable carrier for a rating period, the arithmetic average of	363
the applicable base premium rate and the corresponding highest	364
premium rate.	365

(L) "Pre-existing conditions provision" means a policy	366
provision that excludes or limits coverage for charges or expenses	367
incurred during a specified period following the insured's	368
enrollment date as to a condition for which medical advice,	369
diagnosis, care, or treatment was recommended or received during a	370
specified period immediately preceding the enrollment date.	371
Genetic information shall not be treated as such a condition in	372
the absence of a diagnosis of the condition related to such	373
information.	374

For purposes of this division, "enrollment date" means, with	375
respect to an individual covered under a group health benefit	376
plan, the date of enrollment of the individual in the plan or, if	377
earlier, the first day of the waiting period for such enrollment.	378

(M) "Service waiting period" means the period of time after	379
employment begins before an employee is eligible to be covered for	380
benefits under the terms of any applicable health benefit plan	381
offered by the small employer.	382

(N)(1) "Small employer" means, until January 1, 2016, in	383
connection with a group health benefit plan and with respect to a	384
calendar year and a plan year, an employer who employed an average	385
of at least two but no more than fifty eligible employees on	386
business days during the preceding calendar year and who employs	387
at least two employees on the first day of the plan year and, on	388
and after January 1, 2016, an employer that employed an average of	389
not more than one hundred employees during the preceding calendar	390
year.	391

(2) For purposes of division (N)(1) of this section, all	392
persons treated as a single employer under subsection (b), (c),	393
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	394
100 Stat. 2085, 26 U.S.C.A. 1, as amended, shall be considered one	395
employer. In the case of an employer that was not in existence	396
throughout the preceding calendar year, the determination of	397
whether the employer is a small or large employer shall be based	398
on the average number of eligible employees that it is reasonably	399
expected the employer will employ on business days in the current	400
calendar year. Any reference in division (N) of this section to an	401
"employer" includes any predecessor of the employer. Except as	402
otherwise specifically provided, provisions of sections 3924.01 to	403
3924.14 of the Revised Code that apply to a small employer that	404
has a health benefit plan shall continue to apply until the plan	405
anniversary following the date the employer no longer meets the	406
requirements of this division.	407

(O) "OHC plan" means an Ohio health care plan, which is the	408
basic, standard, or carrier reimbursement plan for small employers	409
and individuals established in accordance with section 3924.10 of	410
the Revised Code.	411

Sec. 3965.01. (A) The purpose of this chapter is to provide	412
for the establishment of an Ohio health benefit exchange agency	413
and an Ohio health benefit exchange program to facilitate the	414
purchase and sale of qualified health plans in the individual	415
market in this state, and to provide for the establishment of a	416
small business health options program as a part of the Ohio health	417
benefit exchange program to assist qualified small employers in	418
this state in facilitating the enrollment of their employees in	419
qualified health plans offered in the small group market.	420

(B) The Ohio general assembly declares that the following	421
objectives are to be served by this chapter:	422

(1) Extend access to high quality, affordable health plans to	423
all Ohioans;	424

(2) Reduce the number of uninsured Ohioans by creating a	425
cost-effective, user-friendly, and transparent marketplace to help	426
consumers and employers select high quality, affordable health	427
plans and claim available federal tax credits and cost-sharing	428
subsidies;	429

(3) Strengthen the health care delivery system;

430

(4) Guarantee the availability and renewability of health	431
care coverage through the private health insurance market to	432
qualified individuals and qualified small employers;	433

(5) Require that health care service plans and health	434
insurers issuing coverage in the individual and small employer	435
markets compete on the basis of price, quality, and service, not	436
on risk selection;	437

(6) Meet the requirements of the federal act and applicable	438
federal guidance and regulations.	439

Sec. 3965.02. As used in this chapter:

440

(A) "Carrier" means any sickness and accident insurance	441
company or health insuring corporation authorized to issue health	442
benefit plans in this state.	443

(B) "Exchange" or "exchange program" means the Ohio health	444
benefit exchange program established in section 3965.05 of the	445
Revised Code.	446

(C) "Exchange agency" means the Ohio health benefit exchange	447
agency established in section 3965.03 of the Revised Code.	448

(D) "Federal act" means the federal "Patient Protection and	449
Affordable Care Act of 2010," 124 Stat. 119, as amended by the	450
federal "Health Care and Education Reconciliation Act of 2010,"	451
124 Stat. 1029, and any amendments to those acts, or regulations	452
or guidance issued under those acts.	453

(E) "Health benefit plan" means a policy, contract,	454
certificate, or agreement offered or issued by a carrier to	455
provide, deliver, arrange for, pay for, or reimburse any of the	456
costs of health care services. "Health benefit plan" does not	457
include any of the following:	458

(1) Policies covering only accident or disability income;

459

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

460

(3) Liability insurance, including general liability	461
insurance and automobile liability insurance;	462

(4) Workers' compensation or similar insurance;

463

(5) Automobile medical payment insurance;

464

(6) Credit-only insurance;

465

(7) Coverage for on-site medical clinics;

466

(8) Other similar insurance coverage under which benefits for	467
health care services are secondary or incidental to other	468
insurance benefits;	469

(9) Any plan offering the benefits or coverage described in	470
division (D) of section 3965.06 of the Revised Code.	471

(F) "Qualified dental plan" means a limited scope dental plan	472
that has been certified in accordance with section 3965.07 of the	473
Revised Code.	474

(G) "Qualified employer" means a small employer that meets	475
the criteria for a qualified employer established in section	476
3965.11 of the Revised Code.	477

(H) "Qualified health plan" means a health benefit plan that	478
has been certified pursuant to section 3965.06 of the Revised	479
Code.	480

(I) "Qualified individual" means an individual who meets the	481
criteria for a qualified individual established in section 3965.10	482
of the Revised Code.	483

(J) "Secretary" means the secretary of the United States	484
department of health and human services.	485

(K) "SHOP exchange" means the small business health options	486
program established in section 3965.11 of the Revised Code.	487

(L)(1) "Small employer" means, until January 1, 2016, an	488
employer that employed an average of not more than fifty employees	489
during the preceding calendar year and, on and after January 1,	490
2016, an employer that employed an average of not more than one	491
hundred employees during the preceding calendar year.	492

(2) For the purposes of division (L)(1) of this section, all	493
persons treated as a single employer under subsection (b), (c),	494
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	495
100 Stat. 2085, 26 U.S.C. 1, as amended, shall be treated as a	496
single employer. Any reference in division (L) of this section to	497
an "employer" includes any predecessor of the employer. In the	498
case of an employer that was not in existence throughout the	499
preceding calendar year, the determination of whether the employer	500
is a small or large employer shall be based on the average number	501
of eligible employees that the employer is reasonably expected to	502
employ on business days in the current calendar year. All	503
employees shall be counted, including part-time employees and	504
employees who are not eligible for coverage through the employer.	505

Sec. 3965.03. (A) The Ohio health benefit exchange agency is	506
hereby created. The agency shall have a board of directors	507
consisting of the following members:	508

(1) The following individuals, as part of their appointed	509
roles:	510

(a) The superintendent of insurance, or the superintendant's	511
designee;	512

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

513

514

(2) The following members appointed by the governor following	515
the nomination process described in section 3965.04 of the Revised	516
Code. Not more than half shall be members of the same political	517
party, none shall have been employed by or worked as an insurance	518
agent or health care provider in the three years prior to	519
appointment, and all shall be residents of this state. At least	520
one of the six appointed members of the board shall have knowledge	521
of best practices used to address disparities in quality, access,	522
and affordability of health care.	523

(a) One individual who, on account of the individual's	524
present or previous vocation, employment, or affiliations, can be	525
classified as a union representative;	526

(b) One individual who, on account of the individual's	527
present or previous vocation, employment, or affiliations, can be	528
classified as a consumer representative;	529

(c) One individual who, on account of the individual's	530
present or previous vocation, employment, or affiliations, can be	531
classified as a small business representative;	532

(d) One individual who, on account of the individual's	533
present or previous vocation, employment, or affiliations, can be	534
classified as an actuary;	535

(e) One individual who, on account of the individual's	536
present or previous vocation, employment, or affiliations, can be	537
classified as an economist;	538

(f) One individual who, on account of the individual's	539
present or previous vocation, employment, or affiliations, can be	540
classified as an employee benefits specialist.	541

(B) The board shall not include health care providers or	542
their representatives, or insurers or their representatives,	543
brokers, or agents.	544

(C)(1) Of the initial appointments made to the board under	545
division (A)(2) of this section, the governor shall appoint two	546
members to a term ending on June 30, 2014, two members to a term	547
ending on June 30, 2015, and two members to a term ending on June	548
30, 2016. Thereafter, terms of office shall be for three years,	549
with each term ending on the same day of the same month as did the	550
term that it succeeds. Each member shall hold office from the date	551
of the member's appointment until the end of the term for which	552
the member was appointed.	553

(2) The governor shall not appoint any person to more than	554
two full terms of office on the board. This restriction does not	555
prevent the governor from appointing a person to fill a vacancy	556
caused by the death, resignation, or removal of a board member and	557
also appointing that person twice to full terms on the board, or	558
from appointing a person previously appointed to fill less than a	559
full term twice to full terms on the board.	560

(3) Vacancies shall be filled in accordance with division (F)	561
of section 3965.04 of the Revised Code. Any member appointed to	562
fill a vacancy occurring prior to the expiration date of the term	563
for which the member's predecessor was appointed shall hold office	564
as a member for the remainder of that term. A member shall	565
continue in office subsequent to the expiration date of the	566
member's term until a successor takes office or until a period of	567
sixty days has elapsed, whichever occurs first.	568

(D) All members of the board shall receive their reasonable	569
and necessary expenses pursuant to section 126.31 of the Revised	570
Code while engaged in the performance of their duties as members	571
and all members described in division (A)(2) of this section also	572
shall receive an annual salary not to exceed sixty thousand	573
dollars in total, payable on the following basis:	574

(1) Except as provided in division (D)(2) of this section, a	575
member shall receive five thousand dollars during a month in which	576
the member attends one or more meetings of the board and shall	577
receive no payment during a month in which the member attends no	578
meeting of the board.	579

(2) A member may receive not more than sixty thousand dollars	580
per year to compensate the member for attending meetings of the	581
board, regardless of the number of meetings held by the board	582
during a year or the number of meetings in excess of twelve within	583
a year that the member attends.	584

(E) The board shall set meeting dates as necessary to perform	585
the duties of the board under this chapter. The board shall meet	586
at least twelve times per year. A majority of the members shall	587
constitute a quorum.	588

(F) Before entering the duties of office, each appointed	589
member to the board described in division (A)(2) of this section	590
shall take an oath of office as required by sections 3.22 and 3.23	591
of the Revised Code.	592

(G) The board may appoint an advisory committee to the board	593
that shall consist of ten, eleven, or twelve individuals who	594
represent stakeholders, but who shall not vote on the matters	595
before the board. The advisory committee may include all of the	596
following individuals:	597

(1) Representatives of health insuring corporations;

598

(2) Insurance brokers;

599

(3) Health care providers;

600

(4) Consumers, including persons with disabilities;

601

(5) Small business owners;

602

(6) Representatives of organizations or community members	603
that represent ethnic, racial, and rural communities;	604

(7) Others as the board sees fit.

605

(H) The board is responsible for the effective operation of	606
all exchange agency responsibilities and the compliance of the	607
exchange agency and the exchange program with all federal and	608
state rules and regulations. The board shall do all of the	609
following:	610

(1) Exercise all powers reasonably necessary to carry out and	611
comply with the duties, responsibilities, and requirements of this	612
chapter and the federal act;	613

(2) Hire an executive director who shall be in the	614
unclassified civil service. The executive director shall be	615
responsible for the operation of the exchange program.	616

(3) Set the salaries for staff hired by the executive	617
director pursuant to section 3965.05 of the Revised Code that are	618
in amounts reasonably necessary to attract and retain individuals	619
of superior qualifications, publish those salaries in the board's	620
annual budget, and post the board's annual budget on the web site	621
of the exchange agency.	622

(4) Consult with stakeholders relevant to carrying out the	623
activities applicable to the board under this chapter, including	624
all of the following:	625

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

626

(b) Individuals and entities with experience in facilitating	627
enrollment in health plans;	628

(c) Representatives of small businesses and self-employed	629
individuals;	630

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

631

(5) Develop standardized quality measures to evaluate health	632
benefit plans pursuant to division (A)(7)(g) of section 3965.06 of	633
the Revised Code;	634

(6) Establish a navigator program in accordance with section	635
3965.09 of the Revised Code and select individuals and entities	636
for the navigator program using the criteria listed in that	637
section;	638

(7) Develop privacy policies in accordance with relevant	639
federal and state law, rule, and regulation to protect sensitive	640
applicant and enrollee information;	641

(8) Adopt bylaws for the regulation of its affairs and the	642
conduct of its business.	643

(I) The board may sue and be sued in the name of the exchange	644
agency.	645

Sec. 3965.04. (A) There is hereby created an exchange agency	646
board of directors nominating council consisting of the following	647
individuals:	648

(1) The chief executive officer of AARP, or that officer's	649
designee;	650

(2) The executive director of the Ohio developmental	651
disabilities council, or the executive director's designee;	652

(3) The director or equivalent representative of the Ohio	653
small business council of the Ohio chamber of commerce, or the	654
director or equivalent representative's designee;	655

(4) The chairperson of the board of directors of the council	656
of smaller enterprises, or the chairperson's designee;	657

(5) The executive director of the universal health care	658
action network of Ohio, or the executive director's designee;	659

(6) The president of the Ohio AFL-CIO, or the president's	660
designee;	661

(7) The president or equivalent representative of the largest	662
public employee organization in this state, or the president or	663
equivalent representative's designee;	664

(8) The president of the health policy institute of Ohio, or	665
the president's designee;	666

(9) The executive director of the Ohio commission on minority	667
health, or the executive director's designee;	668

(10) The chairperson of the department of economics at the	669
Ohio state university, or the chairperson's designee;	670

(11) The president of the Ohio association of health plans,	671
or the president's designee;	672

(12) The president of the Ohio state medical association, or	673
the president's designee;	674

(13) The chief executive officer of the Ohio hospital	675
association, or that officer's designee;	676

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

677

(15) An individual selected by the speaker of the house of	678
representatives.	679

(B) At its first meeting each calendar year, the council	680
shall select from among its members a chairperson and secretary.	681
The council may adopt bylaws governing its proceedings.	682

(C) The council shall keep a record of its proceedings.	683
Special meetings may be called by the chairperson, and shall be	684
called by the chairperson upon receipt of a written request for a	685
meeting signed by two or more members of the council. Written	686
notice of the time and place of each meeting shall be sent to each	687
member of the council. Eight members, or their alternates,	688
constitute a quorum.	689

(D) The council shall:

690

(1) Review and evaluate possible appointees for the office of	691
exchange board director of the Ohio health benefit exchange	692
agency;	693

(2) Consistent with section 3965.03 of the Revised Code, not	694
more than eighty-five nor less than sixty days prior to the	695
expiration of the term of an exchange board director or not more	696
than thirty days after the death of, resignation of, or	697
termination of service by, an exchange board director, provide the	698
governor with a list of four individuals who are, in the judgment	699
of the council, the most fully qualified to accede to the office	700
of exchange board director. The council shall not include the name	701
of an individual upon the list, if the appointment of that	702
individual by the governor would result in more than three	703
appointed members of the board of directors belonging to or being	704
affiliated with the same political party.	705

(E) In reviewing and evaluating possible appointees for the	706
office of exchange board director, the council may accept comments	707
from, cooperate with, and request information from any person. The	708
council may make recommendations to the general assembly	709
concerning changes in legislation to assist the council in the	710
performance of its duties.	711

(F) Within thirty days of receipt of the council's	712
recommendations, the governor shall fill a vacancy occurring in	713
the office of exchange board director by appointment of one of the	714
persons recommended by the council. Nothing in this section shall	715
prevent the governor in the governor's discretion from rejecting	716
all of the nominees of the council and reconvening the council in	717
order to select four additional nominees. However, when the	718
governor has reconvened the council and the council has provided	719
the governor with a second list of four names, the governor shall	720
make the appointment from one of the names on the first list or	721
the second list. Each appointment by the governor shall be subject	722
to the advice and consent of the senate.	723

(G) Members of the council shall be compensated on a per diem	724
basis pursuant to the procedures set forth in section 124.14 of	725
the Revised Code plus reasonable travel expenses. All the expenses	726
of the nominating council shall be paid from moneys appropriated	727
to the exchange agency for that purpose.	728

Sec. 3965.05. (A) There is hereby created the Ohio health	729
benefit exchange program within the Ohio health benefit exchange	730
agency consisting of an exchange for individual coverage and a	731
SHOP exchange. The executive director of the exchange agency shall	732
be responsible for operating the exchange and shall hire all	733
necessary staff to meet the responsibilities of the executive	734
director as described in this section. All staff hired by the	735
executive director shall be in the classified civil service.	736

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

737

(1) Make qualified health plans available to qualified	738
individuals and qualified employers beginning on January 1, 2014;	739

(2) Establish procedures by rule for the certification,	740
recertification, and decertification of health benefit plans as	741
qualified health plans pursuant to section 3965.06 of the Revised	742
Code and consistent with guidelines developed by the secretary	743
under section 1311(c) of the federal act;	744

(3) Provide for the operation of a toll-free telephone	745
hotline to respond to requests for assistance regarding the	746
exchange;	747

(4) Establish enrollment periods, consistent with the	748
requirements of section 1311(c)(6) of the federal act;	749

(5) Maintain a web site through which individuals can enroll	750
in qualified health plans, and through which enrollees and	751
applicants can obtain standardized comparative information on such	752
plans;	753

(6) Assign a rating to each qualified health plan offered	754
through the exchange in accordance with the criteria developed by	755
the secretary under section 1311(c)(3) of the federal act, and	756
determine the level of coverage of each qualified health plan in	757
accordance with regulations issued by the secretary under section	758
1302(d)(2)(A) of the federal act;	759

(7) Ensure that throughout the state a choice of qualified	760
health plans are provided at the catastrophic, bronze, silver,	761
gold, and platinum levels of coverage as those levels are	762
described in sections 1302(d) and (e) of the federal act. A	763
particular plan may be available in one region of the state and	764
not others so long as throughout the state there is a comparable	765
selection of options at each coverage level.	766

(8) Use a standardized format for presenting health benefit	767
options in the exchange, including the use of the uniform outline	768
of coverage established under section 2715 of the "Public Health	769
Service Act," 124 Stat. 132, 42 U.S.C. 300gg-15 (2010);	770

(9) Inform individuals of eligibility requirements for the	771
programs listed in division (B) of section 3965.10 of the Revised	772
Code and enroll all eligible individuals in those programs;	773

(10) Grant certifications attesting that individuals are	774
exempt from the individual responsibility requirement and penalty	775
under section 5000A of the "Internal Revenue Code of 1986," 124	776
Stat. 1215, if individuals meet the criteria listed in division	777
(C) of section 3965.10 of the Revised Code;	778

(11) Establish and make available by electronic means a	779
calculator to determine the actual cost of coverage after	780
application of any premium tax credit under section 36B of the	781
"Internal Revenue Code of 1986," 125 Stat. 168, and any	782
cost-sharing reduction under section 1402 of the federal act;	783

(12) Transfer to the United States secretary of the treasury	784
all of the following:	785

(a) A list of the individuals who are issued a certification	786
under division (B)(10) of this section, including the name and	787
taxpayer identification number of each individual;	788

(b) The name and taxpayer identification number of each	789
individual who was an employee of an employer but who was	790
determined to be eligible for the premium tax credit under section	791
36B of the "Internal Revenue Code of 1986," 125 Stat. 168, because	792
of either of the following reasons:	793

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

794

(ii) The employer provided the minimum essential coverage,	795
but it was determined under section 36B(c)(2)(C) of the "Internal	796
Revenue Code of 1986," 125 Stat. 168, to either be unaffordable to	797
the employee or not to provide the required minimum actuarial	798
value.	799

(c) The name and taxpayer identification number of both of	800
the following:	801

(i) Each individual who notifies the executive director	802
pursuant to section 1411(b)(4) of the federal act that the	803
individual has changed employers;	804

(ii) Each individual who ceases coverage under a qualified	805
health plan during a plan year and the effective date of that	806
cessation.	807

(13) Provide to each employer the name of each employee of	808
the employer described in division (B)(12)(c)(ii) of this section	809
who ceases coverage under a qualified health plan during a plan	810
year and the effective date of the cessation;	811

(14) Review the rate of premium growth within the exchange	812
and outside the exchange, and consider the information in making	813
recommendations to the board of the exchange agency on whether to	814
continue limiting qualified employer status to small employers;	815

(15) Meet the following financial integrity requirements:

816

(a) Keep an accurate accounting of all activities, receipts,	817
and expenditures, and annually submit to the secretary an	818
accounting report as required by section 1313 of the federal act;	819

(b) Conduct an annual fiscal audit;

820

(c) Annually prepare a written report on the implementation	821
and performance of the exchange functions during the preceding	822
fiscal year, including, at a minimum, the manner in which funds	823
were expended and the progress toward, and the achievement of, the	824
requirements of this chapter. This report shall be transmitted to	825
the general assembly and the governor and shall be made available	826
to the public on the web site of the exchange.	827

(d) Fully cooperate with any investigation conducted by the	828
secretary pursuant to the secretary's authority under the federal	829
act and allow the secretary, in coordination with the inspector	830
general of the United States department of health and human	831
services, to do all of the following:	832

(i) Investigate the affairs of the exchange;

833

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

834

(iii) Require periodic reports in relation to the activities	835
undertaken by the exchange.	836

(e) In carrying out the activities of the exchange under this	837
chapter, not use any funds intended for the administrative and	838
operational expenses of the exchange for staff retreats,	839
promotional giveaways, excessive executive compensation, or	840
promotion of federal or state legislative and regulatory	841
modifications.	842

(16) Provide referrals to any applicable office of health	843
insurance consumer assistance or health insurance ombudsman	844
established under section 2793 of the "Public Health Service Act,"	845
124 Stat. 138, 42 U.S.C. 300gg-93 (2010), or the department of	846
insurance for any enrollee with a grievance, complaint, or	847
question regarding the enrollee's health plan, coverage, or a	848
determination under that plan or coverage;	849

(17) Market and publicize the availability of health care	850
coverage and federal subsidies through the exchange including	851
efforts to reach hard-to-reach populations;	852

(18) Before January 1, 2019, conduct an ongoing study of	853
exchange activities and the enrollees in qualified health plans	854
offered through the exchange, including all of the following:	855

(a) A survey of the cost and affordability of insurance	856
provided under both the exchange for individual coverage and the	857
SHOP exchange;	858

(b) The number of physicians by area and specialty who are	859
not taking or accepting new patients who are enrolled in qualified	860
health plans through the exchange;	861

(c) The adequacy of provider networks of qualified health	862
plans.	863

(19) Collaborate with agencies and departments of this state,	864
including the department of job and family services and the	865
department of insurance, to allow an individual to remain enrolled	866
with the individual's carrier and provider network if the	867
individual loses eligibility for premium tax credits and becomes	868
eligible for medicaid, or loses eligibility for medicaid and	869
becomes eligible for premium tax credits through the exchange;	870

(20) Ensure that the privacy of applicants and enrollees in	871
the exchange is protected by enforcing the privacy policies	872
developed by the board of the exchange agency pursuant to division	873
(H)(7) of section 3965.03 of the Revised Code.	874

875

(1) Contract with an eligible entity for any of the functions	876
of the exchange described in this chapter, including the	877
department of job and family services or an entity that has	878
experience in individual and small group health insurance, benefit	879
administration or other experience relevant to the	880
responsibilities to be assumed by the entity. A carrier or an	881
affiliate of a carrier is not an eligible entity.	882

(2) Enter into information-sharing agreements with federal	883
and state agencies and departments and other state health benefit	884
exchange agencies to carry out the responsibilities of the	885
exchange under this chapter, provided those agreements include	886
adequate protections with respect to the confidentiality of the	887
information to be shared and comply with all state and federal	888
laws, rules, and regulations.	889

(3) Make available supplemental coverage for enrollees of the	890
exchange to the extent permitted by the federal act, provided that	891
funds in the Ohio health benefit exchange operating fund	892
established in section 3965.12 of the Revised Code are not used to	893
pay the cost of that coverage. Any supplemental coverage offered	894
in the exchange shall be subject to the charge imposed on	895
qualified health plans under section 3965.12 of the Revised Code.	896

(D) Neither the executive director nor any carrier offering a	897
health benefit plan through the exchange shall do either of the	898
following:	899

(1) Make available on the exchange any health plan that is	900
not a qualified health plan;	901

(2) Charge an individual a fee or penalty for termination of	902
coverage if the individual enrolls in another type of minimum	903
essential coverage because the individual has become newly	904
eligible for that coverage or because the individual's	905
employer-sponsored coverage has become affordable under the	906
standards of section 36B(c)(2)(C) of the "Internal Revenue Code of	907
1986," 125 Stat. 168.	908

(E) All data collection performed by the executive director	909
pursuant to this chapter shall include demographic information,	910
including racial and ethnic information as specified by the	911
executive director in rules adopted in accordance with section	912
3965.13 of the Revised Code.	913

Sec. 3965.06. (A) The executive director of the exchange may	914
certify a health benefit plan as a qualified health plan if all of	915
the following conditions are met:	916

(1) The plan provides the essential health benefits package	917
described in section 1302(a) of the federal act, except that the	918
plan is not required to provide essential benefits that duplicate	919
the minimum benefits of qualified dental plans, as provided in	920
section 3965.07 of the Revised Code, if both of the following are	921
true:	922

(a) The executive director has determined that at least one	923
qualified dental plan is available to supplement the qualified	924
health plan's coverage.	925

(b) The carrier makes prominent disclosure at the time it	926
offers the plan, in a form approved by the executive director,	927
that the plan does not provide the full range of essential	928
pediatric benefits, and that qualified dental plans providing	929
those benefits and other dental benefits not covered by the plan	930
are offered through the exchange.	931

(2) The premium rates and contract language have been	932
approved by the superintendent of insurance.	933

(3) The plan provides at least a bronze level of coverage, as	934
determined pursuant to division (B)(6) of section 3965.05 of the	935
Revised Code unless the plan is certified as a qualified	936
catastrophic plan, which will only be offered to individuals	937
eligible for catastrophic coverage.	938

(4) The plan's cost-sharing requirements do not exceed the	939
limits established under section 1302(c)(1) of the federal act,	940
and, if the plan is offered through the SHOP exchange, the plan's	941
deductible does not exceed the limits established under section	942
1302(c)(2) of the federal act.	943

(5) The carrier offering the plan meets all of the following	944
criteria:	945

(a) The carrier is licensed and in good standing to offer	946
health insurance coverage in this state.	947

(b) The carrier offers at least one qualified catastrophic	948
health plan, at least one qualified health plan in the bronze	949
level, at least one qualified health plan in the silver level, at	950
least one qualified health plan in the gold level, and at least	951
one qualified health plan in the platinum level, as determined by	952
the executive director pursuant to division (B)(6) of section	953
3965.05 of the Revised Code, through the SHOP exchange or the	954
exchange for individual coverage or both if the carrier	955
participates in both the SHOP exchange and the exchange for	956
individual coverage.	957

(c) The carrier charges the same premium rate for each	958
qualified health plan without regard to whether the plan is	959
offered through the exchange and without regard to whether the	960
plan is offered directly from the carrier or through an insurance	961
agent.	962

(d) The carrier does not charge any fee or penalty for	963
termination of coverage in violation of division (D)(2) of section	964
3965.05 of the Revised Code.	965

(e) The carrier complies with the regulations developed by	966
the secretary under section 1311(d) of the federal act and such	967
other requirements as the executive director may establish.	968

(6) The plan meets the requirements of certification as	969
established by rule pursuant to division (B)(2) of section 3965.05	970
of the Revised Code and by the secretary under section 1311(c) of	971
the federal act.	972

(7) The executive director determines that making the plan	973
available through the exchange is in the interest of qualified	974
individuals and qualified employers in this state. In making such	975
a determination, the executive director shall consider all of the	976
following:	977

(a) Plans should not make use of marketing practices that	978
would discourage enrollment by people with significant health	979
needs.	980

(b) Plans must provide a sufficient choice of providers and,	981
where available, must include essential community providers that	982
serve low-income, medically underserved individuals.	983

(c) Plans must be accredited by a recognized accreditation	984
organization, or achieve accreditation from a recognized	985
accreditation organization within a time period defined by the	986
board of the exchange agency, based on a review of their clinical	987
quality, patient experience, access, utilization management,	988
quality assurance, provider credentialing, complaints and appeals	989
processes, network adequacy and access, and patient information	990
programs.	991

(d) Plans must have a quality improvement strategy.

992

(e) Plans must use a uniform enrollment form for individuals	993
and small employers.	994

(f) Plans must use a standard format for presenting plan	995
options.	996

(g) Plans must provide information about their performance on	997
standardized quality measures as determined by the board of the	998
exchange agency under division (H)(5) of section 3965.03 of the	999
Revised Code to enrollees and prospective enrollees.	1000

(h) Plans must report annually to the federal government on	1001
the quality of their pediatric care.	1002

(8) The plan does not offer benefits or coverage described in	1003
division (D) of this section.	1004

(B) The executive director shall not exclude a health benefit	1005
plan from certification for any of the following reasons:	1006

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

1007

(2) Through the imposition of premium price controls by the	1008
exchange;	1009

(3) On the basis that the health benefit plan provides	1010
treatments necessary to prevent patients' deaths in circumstances	1011
the executive director determines are inappropriate or too costly.	1012

(C) The executive director shall require each carrier seeking	1013
certification of a plan as a qualified health plan to do all of	1014
the following:	1015

(1) Submit a justification to the executive director for any	1016
premium increase before implementation of that increase;	1017

(2) Prominently post any information regarding a premium	1018
increase on its web site. The executive director shall take this	1019
information, along with the information and the recommendations	1020
provided to the exchange by the secretary under section 2794(b) of	1021
the "Public Health Service Act," 124 Stat. 139, 42 U.S.C. 300gg-94	1022
(2010), into consideration when determining whether to allow the	1023
carrier to make plans available through the exchange.	1024

(3) Make available to the public, in language that the	1025
intended audience, including individuals with limited English	1026
proficiency, can readily understand, and submit to the exchange,	1027
the secretary, and the superintendent of insurance, accurate and	1028
timely disclosure of all of the following information:	1029

(a) Claims payment policies and practices;

1030

(b) Periodic financial disclosures;

1031

(c) Data on enrollment, disenrollment, the number of claims	1032
that are denied, and rating practices;	1033

(d) Information on cost-sharing and payments with respect to	1034
any out-of-network coverage;	1035

(e) Information on enrollee and participant rights under	1036
Title I of the federal act;	1037

(f) Other information as determined appropriate by the	1038
secretary pursuant to section 1303 of the federal act.	1039

(4) Permit individuals to learn, in a timely manner upon the	1040
request of the individual, the amount of cost-sharing, including	1041
deductibles, copayments, and coinsurance, under the individual's	1042
plan or coverage that the individual would be responsible for	1043
paying with respect to the furnishing of a specific item or	1044
service by a participating provider. At a minimum, this	1045
information shall be made available to the individual through a	1046
web site and through other means for individuals without access to	1047
the internet.	1048

(D) The executive director shall not consider any health	1049
benefit plan for certification as a qualified health plan if the	1050
health benefit plan includes any of the following:	1051

(1) Any of the following benefits if they are provided under	1052
a separate policy, certificate, or contract of insurance or are	1053
otherwise not an integral part of the plan:	1054

(a) Limited scope dental or vision benefits;

1055

(b) Benefits for long-term care, nursing home care, home	1056
health care, or community-based care;	1057

(c) Other similar, limited benefits specified in federal	1058
regulations issued pursuant to the "Health Insurance Portability	1059
and Accountability Act of 1996," 110 Stat. 1936 (1996).	1060

(2) Either of the following benefits if the benefits are	1061
provided under a separate policy, certificate, or contract of	1062
insurance, there is no coordination between the provision of the	1063
benefits and any exclusion of benefits under any health benefit	1064
plan maintained by the same carrier, and the benefits are paid	1065
with respect to an event without regard to whether benefits are	1066
provided with respect to such an event under any health benefit	1067
plan maintained by the same carrier:	1068

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

1069

(b) Hospital indemnity or other fixed indemnity insurance.

1070

(3) Any of the following if offered as a separate policy,	1071
certificate, or contract of insurance:	1072

(a) Medicare supplemental health insurance as defined under	1073
section 1882(g)(1) of the "Social Security Act," 124 Stat. 460, 42	1074
U.S.C. 1395ss (2010);	1075

(b) Coverage supplemental to the coverage provided under	1076
chapter 55 of Title 10 of the United States Code;	1077

(c) Similar supplemental coverage provided to coverage under	1078
a group health plan.	1079

(E) The executive director shall not exempt any carrier	1080
seeking certification of a qualified health plan, regardless of	1081
the type or size of the carrier, from state licensure or solvency	1082
requirements and shall apply the criteria of this section in a	1083
manner that assures a level playing field between or among	1084
carriers participating in the exchange.	1085

Sec. 3965.07. (A) The executive director may certify a	1086
dental plan as a qualified dental plan if all of the following	1087
conditions are met:	1088

(1) The plan provides limited scope dental benefits that are	1089
offered separately from any qualified health plan.	1090

(2) The plan does not substantially duplicate the benefits	1091
typically offered by health benefit plans without dental coverage.	1092

(3) The plan includes, at a minimum, the essential pediatric	1093
dental benefits prescribed by the secretary pursuant to section	1094
1302(b)(1)(J) of the federal act, and such other dental benefits	1095
as the executive director or the secretary may specify by rule or	1096
regulation.	1097

(B) The provisions of this chapter that are applicable to	1098
qualified health plans shall also apply to qualified dental plans	1099
to the extent relevant with the following exceptions:	1100

(1) A carrier that is licensed to offer dental coverage need	1101
not be licensed to offer other health benefits.	1102

(2) Carriers may jointly offer a comprehensive plan through	1103
the exchange in which the dental benefits are provided by a	1104
carrier through a qualified dental plan and the other benefits are	1105
provided by a carrier through a qualified health plan, provided	1106
that the plans are priced separately and are also made available	1107
for purchase separately at the same price.	1108

(C) The executive director may adopt additional rules	1109
concerning qualified dental health plans.	1110

Sec. 3965.08. (A) Health plans that are certified as	1111
qualified health plans pursuant to section 3965.06 of the Revised	1112
Code and dental plans that are certified as qualified dental plans	1113
pursuant to section 3965.07 of the Revised Code may bid to	1114
participate in the exchange for individual coverage and the SHOP	1115
exchange. Bidding plans will be scored by the executive director	1116
of the exchange based on the following criteria:	1117

(1) The cost of the plan to individuals in terms of premiums	1118
and typical out-of-pocket expenses;	1119

(2) The carrier's overall offering and plan design. Preferred	1120
features of health benefit plans include the following:	1121

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

1122

(b) Centers of excellence for complex conditions or	1123
procedures;	1124

1125

(d) Active consumer engagement;

1126

(e) Wellness incentives and management;

1127

(f) Preventive and flex benefits for chronic conditions.

1128

(3) Use of multilingual community outreach or nontraditional	1129
media outlets to reach hard-to-reach communities for marketing	1130
purposes;	1131

(4) The ability of the plan to confirm its compliance with	1132
various program rules and reporting requirements;	1133

(5) The design of the plan's enrollment process, including	1134
the following considerations:	1135

(a) Level of burden to the consumer;

1136

(b) Ease of use with regard to populations that may	1137
experience barriers to enrollment such as the disabled and those	1138
with limited English language proficiency.	1139

(6) A determination of whether including a given plan in the	1140
exchange will encourage a robust system of regional plans.	1141

(B) After consideration of the criteria listed in division	1142
(A) of this section, the executive director shall select qualified	1143
health plans and qualified dental plans to participate in the	1144
exchange. There shall not be a set minimum or maximum number of	1145
qualified health or dental plans that are required to exist in the	1146
exchange.	1147

(C) In the course of selectively contracting for health care	1148
coverage, the executive director shall do both of the following:	1149

(a) Seek to contract with carriers so as to provide health	1150
care coverage choices that offer the optimal combination of	1151
choice, value, quality, and service;	1152

(b) Maintain a robust system of regional plans.

1153

Sec. 3965.09. (A) The board of the exchange agency shall	1154
establish a navigator program in accordance with section 1311(i)	1155
of the federal act, designed to advise individual consumers and	1156
employers on the use of the exchange.	1157

(B) The board shall select individuals and entities to be	1158
part of the navigator program. To be considered for a grant under	1159
the navigator program, an individual or entity shall meet all of	1160
the following criteria:	1161

(1) The individual or entity shall demonstrate to the board	1162
that the individual or entity has existing relationships or could	1163
readily establish relationships with consumers, employers and	1164
employees, or self-employed individuals, likely to be qualified to	1165
enroll in a qualified health plan;	1166

(2) The individual or entity shall not be a health insurance	1167
issuer or receive any compensation, either directly or indirectly,	1168
from any health insurance issuer in connection with the enrollment	1169
of any qualified individuals or employees of a qualified employer	1170
in a qualified health plan;	1171

(3) The individual or entity shall be capable of carrying out	1172
the duties listed in division (C) of this section.	1173

1174

(1) Conduct public education activities to raise awareness of	1175
the availability of qualified health plans;	1176

(2) Distribute fair and impartial information concerning	1177
enrollment in qualified health plans, and the availability of	1178
premium tax credits under section 36B of the "Internal Revenue	1179
Code of 1986," 125 Stat. 168, and cost-sharing reductions under	1180
section 1402 of the federal act;	1181

(3) Facilitate enrollment in qualified health plans;

1182

(4) Provide referrals to any applicable office of health	1183
insurance consumer assistance or health insurance ombudsman	1184
established under section 2793 of the "Public Health Service Act,"	1185
124 Stat. 138, 42 U.S.C. 300gg-93 (2010), or the department of	1186
insurance, for any enrollee with a grievance, complaint, or	1187
question regarding their health benefit plan or coverage or a	1188
determination under that plan or coverage;	1189

(5) Provide information in a manner that is culturally and	1190
linguistically appropriate to the needs of the population being	1191
served by the exchange.	1192

(D) The board shall award grants to individuals and entities	1193
approved by the board to perform work as navigators in order to	1194
fund the required duties described in division (C) of this	1195
section. Funds for grants shall be withdrawn from the Ohio health	1196
benefit exchange operating fund established in section 3965.12 of	1197
the Revised Code.	1198

Sec. 3965.10. (A) Only qualified individuals shall be	1199
permitted to purchase health insurance through the exchange. A	1200
qualified individual is an individual, including a minor, who	1201
meets all of the following criteria:	1202

(1) The individual is seeking to enroll in a qualified health	1203
plan offered to individuals through the exchange.	1204

(2) The individual resides in this state.

1205

(3) The individual is not incarcerated at the time of	1206
enrollment, other than incarceration pending the disposition of	1207
charges.	1208

(4) The individual is, and is reasonably expected to be, for	1209
the entire period for which enrollment is sought, a citizen or	1210
national of the United States, or an alien lawfully present in the	1211
United States.	1212

(B) If the executive director of the exchange program	1213
determines that an individual seeking to purchase health insurance	1214
through the exchange is eligible for the medicaid program under	1215
Title XIX of the "Social Security Act," 124 Stat. 328, 42 U.S.C.	1216
1396 (2010), the children's health insurance program under Title	1217
XXI of the "Social Security Act," 111 Stat. 552, 42 U.S.C. 1397aa	1218
(1997), or any applicable state or local public program, the	1219
executive director shall enroll the individual in that program.	1220

(C) An individual shall be exempt from the individual	1221
responsibility requirement under section 5000A of the "Internal	1222
Revenue Code of 1986," 124 Stat. 1215, or from the penalty imposed	1223
by that section for either of the following reasons:	1224

(1) There is no affordable qualified health plan available	1225
through the exchange, or the individual's employer, covering the	1226
individual.	1227

(2) The individual meets the requirements for any other such	1228
exemption from the individual responsibility requirement or	1229
penalty.	1230

Sec. 3965.11. (A) As a part of the exchange there shall	1231
exist a SHOP exchange through which qualified employers may access	1232
coverage for their employees, and that shall enable any qualified	1233
employer to specify a level of coverage so that any of its	1234
employees may enroll in any qualified health plan offered through	1235
the SHOP exchange at the specified level of coverage.	1236

(B) Only qualified employers shall be permitted to	1237
participate in the SHOP exchange. A qualified employer is a small	1238
employer that elects to make its full-time employees eligible for	1239
one or more qualified health plans offered through the SHOP	1240
exchange, and at the option of the employer, some or all of its	1241
part-time employees, provided that the employer meets either of	1242
the following criteria:	1243

(1) The employer has its principal place of business in this	1244
state and elects to provide coverage through the SHOP exchange to	1245
all of its eligible employees, wherever employed;	1246

(2) The employer elects to provide coverage through the SHOP	1247
exchange to all of its eligible employees who are principally	1248
employed in this state.	1249

(C) If an employer that makes enrollment in qualified health	1250
plans available to its employees through the SHOP exchange would	1251
cease to be a small employer by reason of an increase in the	1252
number of its employees, the employer shall continue to be treated	1253
as a small employer for purposes of this chapter as long as it	1254
continuously makes enrollment through the SHOP exchange available	1255
to its employees.	1256

Sec. 3965.12. (A)(1) The exchange agency may charge	1257
assessments or user fees to carriers or otherwise may generate	1258
funding necessary to support its operations and the operations of	1259
the exchange.	1260

(2) All funds collected by the exchange agency pursuant to	1261
division (A)(1) of this section shall be paid into the state	1262
treasury to the credit of the Ohio health benefit exchange	1263
operating fund, which is hereby created.	1264

(B) The exchange agency shall publish the average costs of	1265
licensing, regulatory fees, and any other payments required by the	1266
exchange agency and the exchange, and the administrative costs of	1267
the exchange agency and the exchange, on a web site to educate	1268
consumers on such costs. This information shall include	1269
information on monies lost to waste, fraud, and abuse.	1270

Sec. 3965.13. The board of the exchange agency and the	1271
executive director of the exchange may adopt rules to implement	1272
the provisions of this chapter. Rules adopted pursuant to this	1273
section shall not conflict with or prevent the application of	1274
regulations promulgated by the secretary under the federal act.	1275

Sec. 3965.14. Nothing in this chapter, and no action taken	1276
by the board of the exchange agency or the executive director of	1277
the exchange pursuant to this chapter, shall be construed to	1278
preempt or supersede the authority of the superintendent of	1279
insurance to regulate the business of insurance within this state.	1280
Except as expressly provided to the contrary in this chapter, all	1281
carriers offering qualified health plans in this state shall	1282
comply fully with all applicable health insurance laws of this	1283
state and rules adopted and orders issued by the superintendent.	1284

Section 2. That existing sections 124.14 and 3924.01 of the	1285
Revised Code are hereby repealed.	1286

Section 3. Within ninety days after the effective date of	1287
this act, the exchange agency board of directors nominating	1288
council established in section 3965.04 of the Revised Code as	1289
enacted in this act shall produce two, three, or four nominees for	1290
each position described in division (A)(2) of section 3965.03 of	1291
the Revised Code. Following nomination, the Governor shall appoint	1292
the members described in that division to the board of the Ohio	1293
Health Benefit Exchange Agency in accordance with division (F) of	1294
section 3965.04 of the Revised Code as enacted in this act. At the	1295
time of appointment, the Governor shall determine which members of	1296
the board shall serve the terms described in division (C)(1) of	1297
section 3965.03 of the Revised Code. For each subsequent	1298
nomination period, the nominating council shall produce four	1299
nominees for each position as required by division (D)(2) of	1300
section 3965.04 of the Revised Code.	1301