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| To amend sections 1739.05 and 1751.35 and to enact | 1 |
| sections 1751.69 and 3923.85 of the Revised Code | 2 |
| regarding insurance coverage for orally | 3 |
| administered cancer medications. | 4 |
| Section 1. That sections 1739.05 and 1751.35 be amended and | 5 |
| sections 1751.69 and 3923.85 of the Revised Code be enacted to | 6 |
| read as follows: | 7 |
| Sec. 1739.05. (A) A multiple employer welfare arrangement | 8 |
| that is created pursuant to sections 1739.01 to 1739.22 of the | 9 |
| Revised Code and that operates a group self-insurance program may | 10 |
| be established only if any of the following applies: | 11 |
| (1) The arrangement has and maintains a minimum enrollment of | 12 |
| three hundred employees of two or more employers. | 13 |
| (2) The arrangement has and maintains a minimum enrollment of | 14 |
| three hundred self-employed individuals. | 15 |
| (3) The arrangement has and maintains a minimum enrollment of | 16 |
| three hundred employees or self-employed individuals in any | 17 |
| combination of divisions (A)(1) and (2) of this section. | 18 |
| (B) A multiple employer welfare arrangement that is created | 19 |
| pursuant to sections 1739.01 to 1739.22 of the Revised Code and | 20 |
| that operates a group self-insurance program shall comply with all | 21 |
| laws applicable to self-funded programs in this state, including | 22 |
| sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381 | 23 |
| to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14, | 24 |
| 3923.24, 3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, | 25 |
| 3923.80, 3923.85, 3924.031, 3924.032, and 3924.27 of the Revised | 26 |
| Code. | 27 |
| (C) A multiple employer welfare arrangement created pursuant | 28 |
| to sections 1739.01 to 1739.22 of the Revised Code shall solicit | 29 |
| enrollments only through agents or solicitors licensed pursuant to | 30 |
| Chapter 3905. of the Revised Code to sell or solicit sickness and | 31 |
| accident insurance. | 32 |
| (D) A multiple employer welfare arrangement created pursuant | 33 |
| to sections 1739.01 to 1739.22 of the Revised Code shall provide | 34 |
| benefits only to individuals who are members, employees of | 35 |
| members, or the dependents of members or employees, or are | 36 |
| eligible for continuation of coverage under section 1751.53 or | 37 |
| 3923.38 of the Revised Code or under Title X of the "Consolidated | 38 |
| Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29 | 39 |
| U.S.C.A. 1161, as amended. | 40 |
| Sec. 1751.35. (A) The superintendent of insurance may | 41 |
| suspend or revoke any certificate of authority issued to a health | 42 |
| insuring corporation under this chapter if the superintendent | 43 |
| finds that: | 44 |
| (1) The health insuring corporation is operating in | 45 |
| contravention of its articles of incorporation, its health care | 46 |
| plan or plans, or in a manner contrary to that described in and | 47 |
| reasonably inferred from any other information submitted under | 48 |
| section 1751.03 of the Revised Code, unless amendments to such | 49 |
| submissions have been filed and have taken effect in compliance | 50 |
| with this chapter. | 51 |
| (2) The health insuring corporation fails to issue evidences | 52 |
| of coverage in compliance with the requirements of section 1751.11 | 53 |
| of the Revised Code. | 54 |
| (3) The contractual periodic prepayments or premium rates | 55 |
| used do not comply with the requirements of section 1751.12 of the | 56 |
| Revised Code. | 57 |
| (4) The health insuring corporation enters into a contract, | 58 |
| agreement, or other arrangement with any health care facility or | 59 |
| provider, that does not comply with the requirements of section | 60 |
| 1751.13 of the Revised Code, or the corporation fails to provide | 61 |
| an annual certificate as required by section 1751.13 of the | 62 |
| Revised Code. | 63 |
| (5) The superintendent determines, after a hearing conducted | 64 |
| in accordance with Chapter 119. of the Revised Code, that the | 65 |
| health insuring corporation no longer meets the requirements of | 66 |
| section 1751.04 of the Revised Code. | 67 |
| (6) The health insuring corporation is no longer financially | 68 |
| responsible and may reasonably be expected to be unable to meet | 69 |
| its obligations to enrollees or prospective enrollees. | 70 |
| (7) The health insuring corporation has failed to implement | 71 |
| the complaint system that complies with the requirements of | 72 |
| section 1751.19 of the Revised Code. | 73 |
| (8) The health insuring corporation, or any agent or | 74 |
| representative of the corporation, has advertised, merchandised, | 75 |
| or solicited on its behalf in contravention of the requirements of | 76 |
| section 1751.31 of the Revised Code. | 77 |
| (9) The health insuring corporation has unlawfully | 78 |
| discriminated against any enrollee or prospective enrollee with | 79 |
| respect to enrollment, disenrollment, or price or quality of | 80 |
| health care services. | 81 |
| (10) The continued operation of the health insuring | 82 |
| corporation would be hazardous or otherwise detrimental to its | 83 |
| enrollees. | 84 |
| (11) The health insuring corporation has submitted false | 85 |
| information in any filing or submission required under this | 86 |
| chapter or any rule adopted under this chapter. | 87 |
| (12) The health insuring corporation has otherwise failed to | 88 |
| substantially comply with this chapter or any rule adopted under | 89 |
| this chapter. | 90 |
| (13) The health insuring corporation is not operating a | 91 |
| health care plan. | 92 |
| (14) The health insuring corporation has failed to comply | 93 |
| with any of the requirements of sections 1751.77 to 1751.87 or | 94 |
| Chapter 3922. of the Revised Code. | 95 |
| (15) The health insuring corporation has failed to comply | 96 |
| with section 1751.69 of the Revised Code. | 97 |
| (B) A certificate of authority shall be suspended or revoked | 98 |
| only after compliance with the requirements of Chapter 119. of the | 99 |
| Revised Code. | 100 |
| (C) When the certificate of authority of a health insuring | 101 |
| corporation is suspended, the health insuring corporation, during | 102 |
| the period of suspension, shall not enroll any additional | 103 |
| subscribers or enrollees except newborn children or other newly | 104 |
| acquired dependents of existing subscribers or enrollees, and | 105 |
| shall not engage in any advertising or solicitation whatsoever. | 106 |
| (D) When the certificate of authority of a health insuring | 107 |
| corporation is revoked, the health insuring corporation, following | 108 |
| the effective date of the order of revocation, shall conduct no | 109 |
| further business except as may be essential to the orderly | 110 |
| conclusion of the affairs of the health insuring corporation. The | 111 |
| health insuring corporation shall engage in no further advertising | 112 |
| or solicitation whatsoever. The superintendent, by written order, | 113 |
| may permit such further operation of the health insuring | 114 |
| corporation as the superintendent may find to be in the best | 115 |
| interest of enrollees, to the end that enrollees will be afforded | 116 |
| the greatest practical opportunity to obtain continuing health | 117 |
| care coverage. | 118 |
| Sec. 1751.69. (A) Notwithstanding section 3901.71 of the | 119 |
| Revised Code and subject to division (B) of this section, no | 120 |
| individual or group health insuring corporation policy, contract, | 121 |
| or agreement providing basic health care services or prescription | 122 |
| drug services that is delivered, issued for delivery, or renewed | 123 |
| in this state, if the policy, contract, or agreement provides | 124 |
| coverage for cancer chemotherapy treatment, shall fail to comply | 125 |
| with any of the following: | 126 |
| (1) The policy, contract, or agreement shall not provide | 127 |
| coverage for a prescribed, orally administered cancer medication | 128 |
| on a less favorable basis than the coverage it provides for | 129 |
| intraveneously administered or injected cancer medications. This | 130 |
| includes a prohibition on imposing a coverage limit, copayment, | 131 |
| coinsurance, deductible, or other out-of-pocket expense that is | 132 |
| greater than any coverage limit, copayment, coinsurance, | 133 |
| deductible, or other out-of-pocket expense in the policy, | 134 |
| contract, or agreement that applies to coverage for intraveneously | 135 |
| administered or injected cancer medications. | 136 |
| (2) The policy, contract, or agreement shall not impose a | 137 |
| coverage limit, copayment, coinsurance, deductible, or other | 138 |
| out-of-pocket expense on a prescribed, orally administered cancer | 139 |
| medication or intraveneously administered or injected cancer | 140 |
| medication that is greater than the coverage limit, copayment, | 141 |
| coinsurance, deductible, or other out-of-pocket expense that | 142 |
| applies to the medication on the effective date of this section. | 143 |
| (3) The policy, contract, or agreement shall not place a | 144 |
| prescribed, orally administered cancer medication or | 145 |
| intraveneously administered or injected cancer medication in a | 146 |
| more expensive price tier than the price tier the medication is in | 147 |
| on the effective date of this section. | 148 |
| (4) The policy, contract, or agreement shall not impose | 149 |
| conditions on an enrollee's treatment with prescribed, orally | 150 |
| administered cancer medication or intraveneously administered or | 151 |
| injected cancer medication that are more restrictive than the | 152 |
| conditions that apply to an enrollee's treatment with the | 153 |
| medication on the effective date of this section. | 154 |
| (B) The prohibitions in division (A) of this section do not | 155 |
| preclude an individual or group health insuring corporation | 156 |
| policy, contract, or agreement from requiring an enrollee to | 157 |
| obtain prior authorization before orally administered cancer | 158 |
| medication is dispensed to the enrollee. | 159 |
| (C) The superintendent of insurance may conduct hearings to | 160 |
| determine whether violations of this section have occurred. The | 161 |
| hearings shall be conducted in accordance with Chapter 119. of the | 162 |
| Revised Code. | 163 |
| (D) If the superintendent, by written order, finds that a | 164 |
| health insuring corporation has violated this section, the | 165 |
| superintendent may do one or more of the following: | 166 |
| (1) Issue an order requiring the health insuring corporation | 167 |
| to cease and desist from engaging in the violation; | 168 |
| (2) Pursuant to division (A)(15) of section 1751.35 of the | 169 |
| Revised Code, suspend or revoke the health insuring corporation's | 170 |
| certificate of authority issued under this chapter; | 171 |
| (3) Order the health insuring corporation neither to employ | 172 |
| any individual who is associated with the violation nor permit | 173 |
| such an individual to serve as a director, consultant, or in any | 174 |
| other capacity for a duration of time the superintendent | 175 |
| determines would best serve the public interest. | 176 |
| (E) In addition to the sanctions the superintendent may | 177 |
| impose under division (D) of this section, a court may do either | 178 |
| or both of the following: | 179 |
| (1) Impose a civil penalty on the health insuring | 180 |
| corporation, not to exceed an aggregate amount of thirty-five | 181 |
| thousand dollars, for one or more violations of this section that | 182 |
| occur in any six-month period; | 183 |
| (2) Impose a civil penalty on the health insuring corporation | 184 |
| not to exceed ten thousand dollars for each violation of a cease | 185 |
| and desist order described in division (D)(1) of this section. | 186 |
| (F) All money collected under this section shall be deposited | 187 |
| in the state treasury to the credit of the department of insurance | 188 |
| operating fund and shall be used only for the purpose of enforcing | 189 |
| this section and sections 1751.69 and 3923.85 of the Revised Code. | 190 |
| Sec. 3923.85. (A) Notwithstanding section 3901.71 of the | 191 |
| Revised Code and subject to division (B) of this section, no | 192 |
| individual or group policy of sickness and accident insurance that | 193 |
| is delivered, issued for delivery, or renewed in this state and no | 194 |
| public employee benefit plan that is established or modified in | 195 |
| this state shall fail to comply with any of the following: | 196 |
| (1) The policy or plan shall not provide coverage for a | 197 |
| prescribed, orally administered cancer medication on a less | 198 |
| favorable basis than the coverage it provides for intraveneously | 199 |
| administered or injected cancer medications. This includes a | 200 |
| prohibition on imposing a coverage limit, copayment, coinsurance, | 201 |
| deductible, or other out-of-pocket expense that is greater than | 202 |
| any coverage limit, copayment, coinsurance, deductible, or other | 203 |
| out-of-pocket expense in the policy or plan that applies to | 204 |
| coverage for intraveneously administered or injected cancer | 205 |
| medications. | 206 |
| (2) The policy or plan shall not impose a coverage limit, | 207 |
| copayment, coinsurance, deductible, or other out-of-pocket expense | 208 |
| on a prescribed, orally administered cancer medication or | 209 |
| intraveneously administered or injected cancer medication that is | 210 |
| greater than the coverage limit, copayment, coinsurance, | 211 |
| deductible, or other out-of-pocket expense that applies to the | 212 |
| medication on the effective date of this section. | 213 |
| (3) The policy or plan shall not place a prescribed, orally | 214 |
| administered cancer medication or intraveneously administered or | 215 |
| injected cancer medication in a more expensive price tier than the | 216 |
| price tier the medication is in on the effective date of this | 217 |
| section. | 218 |
| (4) The policy or plan shall not impose conditions on an | 219 |
| insured's or plan member's treatment with prescribed, orally | 220 |
| administered cancer medication or intraveneously administered or | 221 |
| injected cancer medication that are more restrictive than the | 222 |
| conditions that apply to an insured's or plan member's treatment | 223 |
| with the medication on the effective date of this section. | 224 |
| (B) The prohibitions in division (A) of this section do not | 225 |
| preclude an individual or group policy of sickness and accident | 226 |
| insurance or public employee benefit plan from requiring an | 227 |
| insured or plan member to obtain prior authorization before orally | 228 |
| administered cancer medication is dispensed to the insured or plan | 229 |
| member. | 230 |
| (C) The superintendent of insurance may conduct hearings to | 231 |
| determine whether violations of this section have occurred. The | 232 |
| hearings shall be conducted in accordance with Chapter 119. of the | 233 |
| Revised Code. | 234 |
| (D) If the superintendent, by written order, finds that a | 235 |
| person has violated this section, the superintendent may do one or | 236 |
| more of the following: | 237 |
| (1) Issue an order requiring the person to cease and desist | 238 |
| from engaging in the violation; | 239 |
| (2) Suspend or revoke the person's license to engage in the | 240 |
| business of insurance under this chapter; | 241 |
| (3) Order the person neither to employ any individual who is | 242 |
| associated with the violation nor permit such an individual to | 243 |
| serve as a director, consultant, or in any other capacity for a | 244 |
| duration of time the superintendent determines would best serve | 245 |
| the public interest. | 246 |
| (E) In addition to the sanctions the superintendent may | 247 |
| impose under division (D) of this section, a court may do either | 248 |
| or both of the following: | 249 |
| (1) Impose a civil penalty on the person, not to exceed an | 250 |
| aggregate amount of thirty-five thousand dollars, for one or more | 251 |
| violations of this section that occur in any six-month period; | 252 |
| (2) Impose a civil penalty on the person not to exceed ten | 253 |
| thousand dollars for each violation of a cease and desist order | 254 |
| described in division (D)(1) of this section. | 255 |
| (F) All money collected under this section shall be deposited | 256 |
| in the state treasury to the credit of the department of insurance | 257 |
| operating fund and shall be used only for the purpose of enforcing | 258 |
| this section and section 1751.69 of the Revised Code. | 259 |
| Section 2. That existing sections 1739.05 and 1751.35 of the | 260 |
| Revised Code are hereby repealed. | 261 |
| Section 3. This act shall be known as the "Robert L. Schuler | 262 |
| Act" in honor of the late Robert L. Schuler who served in both the | 263 |
| Ohio House of Representatives and the Ohio Senate. | 264 |
| Section 4. Sections 1739.05 and 1751.69 of the Revised Code, | 265 |
| as amended or enacted by this act, apply only to policies, | 266 |
| contracts, and agreements that are delivered, issued for delivery, | 267 |
| or renewed in this state on or after the effective date of this | 268 |
| act. Section 3923.85 of the Revised Code, as enacted by this act, | 269 |
| applies only to policies of sickness and accident insurance | 270 |
| delivered, issued for delivery, or renewed in this state and | 271 |
| public employee benefit plans that are established or modified in | 272 |
| this state on or after the effective date of this act. | 273 |