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H. B. No. 281As IntroducedAs Introduced
125th General Assembly | Regular Session | 2003-2004 |
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REPRESENTATIVES Martin, McGregor, Kearns, Seitz, Husted, Schaffer, Webster, Gibbs, Walcher, Carano
A BILL
To amend sections 1739.02, 1739.99, 1751.02, 1751.28, 3901.78, and 3999.99 and to enact sections 1739.27 and 3999.18 of the Revised Code to change the assets that are considered to be admitted assets for purposes of meeting the statutory minimum for health insuring corporations, to provide for criminal and financial penalties for persons establishing or operating unlicensed insurers, and to amend provisions governing the issuance of certificates of compliance to insurers.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1739.02, 1739.99, 1751.02, 1751.28, 3901.78, and 3999.99 be amended and sections 1739.27 and 3999.18 of the Revised Code be enacted to read as follows:
Sec. 1739.02. (A) A trade association, industry
association, or professional association that has been organized
and maintained in good faith for a continuous period of one year
or more for purposes other than obtaining insurance may
establish, maintain, or operate a group self-insurance program
under a multiple employer welfare arrangement that is chartered
and created in this state under sections 1739.01 to 1739.22 of
the Revised Code. (B) Except as provided in section 9.833 and sections
1739.01 to 1739.22 of the Revised Code, no multiple employer
welfare arrangement or other entity by which two or more
employers jointly participate in a common employee welfare
benefit plan shall operate a group self-insurance program in this
state after four months after the effective date of this section. (C) Sections 1739.01 to 1739.22 of the Revised Code do not
apply to any entity that establishes, maintains, or operates a
fully-insured program.
(D) No person shall establish, operate, or maintain a multiple employer welfare arrangement providing benefits through a group self-insurance program in this state unless the multiple employer welfare arrangement has a valid certificate of authority from the superintendent of insurance.
Sec. 1739.27. No insurance agent, broker, or other person shall advertise, solicit, negotiate, collect a premium on, or sell any enrollment in, a group self-insurance program in this state, unless the multiple employer welfare arrangement has a valid certificate of authority from the superintendent of insurance.
Sec. 1739.99. (A) Whoever violates division (B) of section 1739.02 of the Revised
Code is guilty of a felony of the fourth degree.
(B) Whoever violates division (D) of section 1739.02 of the Revised Code is guilty of a felony of the fourth degree.
(C) Whoever violates section 1739.27 of the Revised Code is guilty of a felony of the fifth degree.
(D) If a person is found guilty under this section, the court may award restitution in accordance with section 2929.18 of the Revised Code.
Sec. 1751.02. (A) Notwithstanding any law in this state to the
contrary, any
corporation, as defined in section 1751.01 of the
Revised Code, may apply to the
superintendent of insurance for a certificate of authority to
establish and operate a health insuring corporation. If the corporation
applying for a certificate of authority is a
foreign corporation domiciled in a state without laws
similar to those of this chapter,
the corporation must form a domestic corporation to apply for, obtain, and
maintain a certificate of authority under this chapter. (B) No person shall
establish, operate, or perform the services of a health insuring corporation
in this state
without obtaining a certificate of authority under this
chapter. (C) Except as provided by division (D) of this section,
no political subdivision or department, office, or
institution of this state, or corporation formed by or on behalf of any
political subdivision or department, office, or institution of this state,
shall establish, operate, or perform the services of a health insuring
corporation.
Nothing in this
section shall be construed to preclude a board of county
commissioners, a county board of mental retardation and
developmental disabilities, an alcohol and drug addiction
services board, a board of alcohol, drug addiction, and mental
health services, or a community mental health board, or a public
entity formed by or on behalf of any of these boards, from using
managed care techniques in carrying out the board's or public
entity's duties pursuant to the requirements of
Chapters 307., 329., 340., and
5126. of the Revised
Code. However, no such board
or public entity may operate so as to compete in the private
sector with health insuring corporations holding certificates of
authority under this chapter. (D) A corporation formed by or on behalf of a publicly owned,
operated, or funded hospital or health care facility may apply to the
superintendent for
a certificate of authority under division (A) of this section to
establish and operate a health insuring corporation. (E) A health insuring
corporation shall operate in this state in compliance with this
chapter and Chapter 1753. of the Revised Code, and with sections
3702.51 to 3702.62 of the
Revised
Code, and shall operate in
conformity with its filings with the superintendent under this
chapter, including filings made pursuant to sections 1751.03,
1751.11, 1751.12, and 1751.31 of the
Revised
Code. (F) An insurer licensed under Title XXXIX of
the
Revised Code need not obtain a certificate of
authority as a health insuring corporation to offer an open
panel plan as long as the providers and health care facilities
participating in the open panel plan receive their compensation
directly from the insurer. If the providers and health care
facilities participating in the open panel plan receive their
compensation from any person other than the insurer, or if the
insurer offers a closed panel plan, the insurer must obtain a
certificate of authority as a health insuring corporation. (G) An intermediary
organization need not obtain a certificate of authority as a
health insuring corporation, regardless of the method of reimbursement to the
intermediary organization,
as long as a health insuring
corporation or a self-insured employer maintains the ultimate responsibility
to assure delivery of all health care services required by the contract
between the health insuring corporation and the subscriber and
the laws of this state or between the self-insured employer and its
employees. Nothing in this section shall be construed to require any
health care facility, provider, health delivery network, or
intermediary organization that contracts with a health insuring
corporation or self-insured employer, regardless of the method
of reimbursement to the health care facility, provider, health
delivery network, or intermediary organization, to obtain a
certificate of authority as a health insuring corporation under
this chapter, unless otherwise provided, in the case of
contracts with a self-insured employer, by operation of the
"Employee
Retirement
Income
Security
Act of 1974," 88
Stat. 829, 29
U.S.C.A.
1001, as amended. (H) Any health delivery
network doing business in this state, including any
health delivery network that is functioning as an intermediary organization
doing business in this
state, that is not required to
obtain a certificate of authority under this chapter shall
certify to the superintendent annually, not later than the
first day of July, and shall
provide a statement signed by the highest ranking official which
includes the following information: (1) The health delivery network's full name and the
address of its principal place of business; (2) A statement that the health delivery network is not
required to obtain a certificate of authority under this chapter
to conduct its business. (I) The superintendent
shall not issue a certificate of authority to a health insuring
corporation that is a provider sponsored organization unless all
health care plans to be offered by the health insuring
corporation provide basic health care services.
Substantially all of the physicians and hospitals with
ownership or control of the provider sponsored organization, as
defined in division (X) of
section 1751.01 of the Revised
Code, shall also be
participating providers for the provision of basic health care
services for health care plans offered by the provider sponsored
organization. If a health insuring corporation that is a
provider sponsored organization offers health care plans that do
not provide basic health care services, the health insuring
corporation shall be deemed, for purposes of section 1751.35 of
the Revised Code, to have failed to substantially
comply with this chapter. Except as specifically provided in this division and in division
(C)(A) of section 1751.28 of the Revised Code,
the provisions of this chapter shall apply to all health insuring corporations
that are provider sponsored organizations in the same manner that these
provisions apply to all health insuring corporations that are not provider
sponsored organizations. (J) Nothing in this section shall be construed to apply to any
multiple employer welfare arrangement operating pursuant to Chapter
1739. of the Revised Code. (K) Any person who
violates division (B) of this
section, and any health delivery network that fails to comply
with division (H) of this
section, is subject to the penalties set forth in section
1751.45 of the Revised
Code.
Sec. 1751.28. (A) As used in
this section: (1) "Admitted assets" includes the investments authorized
by section 1751.25 of the Revised Code, and, in addition to
these investments, only the following:
(a) Petty cash and other
cash funds that are in the health insuring corporation's
principal office or any official branch office and that are
under the control of the corporation;
(b) Immediately withdrawable funds on deposit in demand accounts
in a bank or trust company, or similar funds that are actually in the health
insuring corporation's principal office or any official branch
office at statement date and that are in transit to the bank or
trust company with authentic deposit credit given prior to the
close of business on the fifth bank business day following the
statement date;
(c) The amount fairly
estimated as recoverable on cash deposited in a bank or trust
company the operations of which have been suspended or for which
a receiver has been appointed, if qualifying under this section
prior to the suspension of operations of or the appointment of a
receiver for the bank or trust company;
(d) Bills and accounts
receivable collateralized by securities of the kind in which the
health insuring corporation may invest;
(e) Premiums receivable
from groups or individuals that are not more than ninety days
past due;
(f) Accounts receivable
that are not more than ninety days past due;
(g) Amounts due under
reinsurance arrangements from insurance companies authorized to
do business in this state;
(h) Tax refunds due from
the United
States or any state;
(i) The interest accrued
on mortgage loans that conform to section 3925.08 of the
Revised Code, not exceeding on an
individual loan an aggregate amount of one year's total due and
accrued interest;
(j) The rents accrued
and owing to the health insuring corporation on real and
personal property, directly or beneficially owned, not exceeding
on each individual property the amount of one year's total due
and accrued rent;
(k) Interest or rents
accrued on conditional sales agreements, security interests,
chattel mortgages, and real or personal property under lease to
other corporations, that conform to section 3925.08 of the
Revised
Code, not exceeding on any
individual investment the amount of one year's total due and
accrued interest or rent;
(l) The fixed and
required interest due and accrued on bonds and other similar
evidences of indebtedness, that conform to section 3925.08 of
the Revised Code, and not in default;
(m) Dividends receivable
on shares of stock that conform to section 3925.08
of the Revised Code, provided that the market price taken for valuation
purposes does not include the value of the dividend;
(n) The interest or
dividends due and payable, but not credited, on deposits in
banks and trust companies or on accounts with savings and loan
associations;
(o) Interest accrued on
secured loans that conform to section 3925.08 of the
Revised
Code, not exceeding the amount
of one year's interest on any loan;
(p) Interest accrued on
tax anticipation warrants;
(q) The amortized value
of electronic computer or data processing machines or systems
purchased for use in connection with the business of the health
insuring corporation, including software purchased and developed
specifically for the use and purposes of the corporation;
(r) The cost of
furniture, equipment, and medical equipment, less accumulated
depreciation on the furniture and equipment to be applied pro rata over a
period not to exceed five years, and of medical and
pharmaceutical supplies, that are under the control of the
health insuring corporation, provided these assets do not exceed
fifteen per cent of admitted assets;
(s) Amounts due from
affiliates to the extent that the affiliate has liquid assets
with which to pay the balance and maintain its accounts on a
current basis. Any amount outstanding more than three months
shall be considered not current.
(2) "Liabilities" means the liabilities of the health
insuring corporation as determined by the superintendent of
insurance.
(B) All admitted assets
of a health insuring corporation must be held in the health
insuring corporation's name and must be free and clear of any
encumbrances, pledges, or hypothecation.
(C)(1) Every health
insuring corporation authorized to provide basic health care
services, which health insuring corporation is not a provider sponsored
organization, shall maintain total admitted assets equal to at least
one hundred ten per cent of the liabilities of the corporation.
However, at no time shall the corporation's net worth be less
than one million two hundred thousand dollars.
(2) Every health insuring corporation authorized to
provide only supplemental health care services shall maintain
total admitted assets equal to at least one hundred ten per cent
of the liabilities of the corporation. However, at no time
shall the corporation's net worth be less than five hundred
thousand dollars. (3) Every health insuring corporation authorized to provide only
specialty health care services shall maintain total admitted
assets equal to at least one hundred ten per cent of the
liabilities of the corporation. However, at no time shall the
corporation's net worth be less than two hundred fifty thousand
dollars. (4) Every health insuring corporation authorized to
provide both basic health care services and supplemental health
care services, which health insuring corporation is not a provider sponsored
organization, shall maintain total admitted assets equal to at
least one hundred ten per cent of the liabilities of the
corporation. However, at no time shall the corporation's net
worth be less than one million seven hundred thousand
dollars. (5) Every health insuring corporation authorized to provide
both basic health care services and specialty health care
services, which health insuring corporation is not a provider sponsored
organization, shall maintain total admitted assets equal to at least
one hundred ten per cent of the liabilities of the corporation.
However, at no time shall the corporation's net worth be less
than one million four hundred fifty thousand dollars. (6) Every health insuring corporation authorized to provide
basic health care services, which health insuring corporation is
a provider sponsored organization, shall maintain total admitted
assets equal to at least one hundred ten per cent of the
liabilities of the corporation. However, at no time shall the
corporation's net worth be less than one million dollars. (7) Every health insuring corporation authorized to provide
both basic health care services and supplemental health care
services, which health insuring corporation is a provider
sponsored organization, shall maintain total admitted assets
equal to at least one hundred ten per cent of the liabilities of
the corporation. However, at no time shall the corporation's
net worth be less than one million five hundred thousand
dollars. (8) Every health insuring corporation authorized to provide
both basic health care services and specialty health care
services, which health insuring corporation is a provider
sponsored organization, shall maintain total admitted assets
equal to at least one hundred ten per cent of the liabilities of
the corporation. However, at no time shall the corporation's
net worth be less than one million two hundred fifty thousand
dollars. (D) The admitted value
of any real estate owned by a health insuring corporation,
whether used for the accommodation of the health insuring
corporation's business operations or otherwise, shall be the
original cost plus the cost of improvements, less encumbrances
and accumulated depreciation.
(E)(B) The net worth otherwise required by this section shall be
reduced by an amount representing credit given to reserve liabilities when a
health insuring corporation carries reinsurance with an admitted reinsurer.
However, such an amount shall not affect the minimum amounts set forth in this
section and section 1751.27 of the Revised Code.
(C) A health insuring corporation may only consider those admitted assets in connection with this section that are consistent with the forms, instructions, and manuals for the preparation and reporting of statutory financial statements and other financial information set forth in section 1751.47 of the Revised Code and any rules adopted under that section. (D) All health insuring corporations must comply with this section, as amended, for calendar year 2004 and each calendar year thereafter.
Sec. 3901.78. Upon the filing of each of its annual
statements, or as soon
thereafter as practicable, the
superintendent of insurance shall issue to each
insurance company
or association authorized to do business in this state but not incorporated under the laws of this state a
certificate that it has complied with the laws of this state.
Such
certificate of compliance shall also contain a statement of
the
amounts of the
paid-up capital stock, assets, liabilities,
income,
and expenditures of the
company or association for the
preceding
year, as shown by its annual
statement for that year.
The
superintendent shall issue to each
newly-applying
company or
association
that the
superintendent finds should be
authorized to
do business in this state, a certificate that it has
complied with
the laws of
this state, which certificate shall
contain a
statement of the amounts of its
paid-up capital stock,
assets,
liabilities, income, and expenditures as shown
by a
financial
statement submitted by it, under the oath of its
officers. of compliance, an original of which must be published in accordance with section 3901.781 of the Revised Code in every county where the insurance company or association has an agency. Upon request or in any other circumstance that the superintendent determines to be appropriate, the superintendent may issue other certificates of compliance, which certificates are not subject to section 3901.781 of the Revised Code, to insurance companies and associations authorized to do business in this state. Certificates of compliance either must be on forms established by the national association of insurance commissioners or on such other forms as the superintendent may prescribe.
Sec. 3999.18. (A) No person shall establish, operate, or maintain any entity that delivers, issues for delivery, or renews any policy of sickness and accident insurance or contract for health care services in this state if the entity is required to, but does not, have a valid certificate of authority under Chapter 1751. or Title XXXIX of the Revised Code.
(B) No insurance agent, broker, or other person shall advertise, solicit, negotiate, collect a premium on, or sell any policy of sickness and accident insurance or contract for health care services in this state unless the entity that delivers, issues for delivery, or renews the policy or contract is subject to and has complied with division (A) of this section.
Sec. 3999.99. (A) Whoever violates section 3999.02 of the
Revised Code is guilty of a misdemeanor of the second degree. (B) Whoever violates section 3999.03, 3999.07, 3999.13,
3999.14, or 3999.15 of the Revised Code is guilty of a
misdemeanor of the first degree. (C) Whoever violates section 3999.04, 3999.05, 3999.08, or
3999.09 of the Revised Code is guilty of a misdemeanor of the
fourth degree. (D) Whoever violates section 3999.10 or 3999.11 of the
Revised Code shall be fined five hundred dollars for a first
offense and shall be
fined one thousand dollars for each subsequent offense. (E) Whoever violates section 3999.12 of the Revised Code
shall be fined not less than ten nor more than one thousand
dollars. (F) Whoever violates division (F) of
section 3999.32, division (B) of section 3999.36, or section
3999.37 or 3999.38 of the Revised Code is guilty of a felony of
the fourth degree.
(G) Whoever violates division (A) of section 3999.18 of the Revised Code is guilty of a felony of the fourth degree. (H) Whoever violates division (B) of section 3999.18 of the Revised Code is guilty of a felony of the fifth degree. (I) If a person is found guilty under this section, the court may award restitution in accordance with section 2929.18 of the Revised Code.
Section 2. That existing sections 1739.02, 1739.99, 1751.02, 1751.28, 3901.78, and 3999.99 of the Revised Code are hereby repealed.
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