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(125th General Assembly)
(Substitute Senate Bill Number 43)
AN ACT
To amend section 3917.01 and to enact sections 1739.061, 1751.111, 3923.601, and 3923.83 of the Revised
Code to require the inclusion of specified pharmacy benefits information when health insurers issue or require the use of standardized identification cards or electronic technology for submission of
claims and to amend the definition of "group life insurance" to mean life insurance covering not less than two, rather than not less than ten, employees.
Be it enacted by the General Assembly of the State of Ohio:
SECTION 1. That section 3917.01 be amended and sections 1739.061, 1751.111, 3923.601, and 3923.83 of the Revised
Code be enacted to read as follows:
Sec. 1739.061. (A)(1) This section applies to both of the following: (a) A multiple employer welfare arrangement that issues or requires the use of a standardized identification card or an electronic technology for submission and routing of prescription drug claims;
(b) A person or entity that a multiple employer welfare arrangement contracts with to issue a standardized identification card or an electronic technology described in division (A)(1)(a) of this section. (2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or required use of a
standardized identification card or an electronic
technology for the submission and routing of prescription drug claims in connection with any of the following: (a) Any program or arrangement covering only accident, credit,
dental, disability income, long-term care, hospital indemnity,
medicare supplement, medicare, tricare, specified disease, or
vision care; coverage under a one-time-limited-duration policy of
not longer than six months; coverage issued as a supplement to
liability insurance; insurance arising out of workers'
compensation or similar law; automobile medical payment insurance;
or insurance under which benefits are payable with or without
regard to fault and which is statutorily required to be contained
in any liability insurance policy or equivalent self-insurance. (b) Coverage provided under medicaid, as defined in section 5111.01 of the Revised Code. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of this section to the plan and its administrators. (B) A standardized identification card or an electronic
technology issued or required to be used as
provided in division (A)(1) of this section shall contain uniform
prescription drug information in accordance with
either division (B)(1) or (2) of this section.
(1) The standardized identification card or the electronic technology shall be in a format and
contain information fields approved by the national council for
prescription drug programs or a successor organization, as specified in the council's or successor organization's pharmacy
identification card implementation guide in effect on the first
day of October most immediately preceding the issuance or required use of the standardized identification card or the electronic technology.
(2) If the multiple employer welfare arrangement or person under contract with it to issue a standardized identification card or an electronic technology requires the information for the submission and routing of a claim, the standardized identification card or the electronic technology shall contain any of the
following information:
(a) The name of the multiple employer welfare arrangement;
(b) The individual's name, group number, and identification
number; (c) A telephone number to inquire about pharmacy-related issues;
(d) The issuer's international identification number, labeled as "ANSI BIN" or "RxBIN";
(e) The processor's control number, labeled as "RxPCN";
(f) The individual's pharmacy benefits group number if
different from the insured's medical group number, labeled as
"RxGrp."
(C) If the standardized identification card or the electronic technology issued or required to be used as provided in division (A)(1) of this section is also used for submission and routing of nonpharmacy
claims, the designation "Rx" is required to be included as part of the labels identified in divisions (B)(2)(d) and
(e) of this section if the issuer's international identification number or the processor's control number is different for medical and pharmacy claims.
(D) Each multiple employer welfare arrangement described in division (A) of this section shall annually file a certificate with the superintendent of insurance certifying that it or any person it contracts with to issue a standardized identification card or electronic technology for submission and routing of prescription drug claims complies with this section. (E)(1) Except as provided in division (E)(2) of this section, if there is a change in the information contained in the standardized identification card or the electronic technology issued to an individual, the multiple employer welfare arrangement or person under contract with it to issue a standardized identification card or an electronic technology shall issue a new card or electronic technology to the individual.
(2) A multiple employer welfare arrangement or person under contract with it is not required under division (E)(1) of this section to issue a new card or electronic technology
to an
individual more than once during a twelve-month period.
(F) Nothing in this section shall be construed as requiring a multiple employer welfare arrangement to produce more than one standardized identification card or one electronic technology for use by individuals accessing health care benefits provided under a multiple employer welfare arrangement.
Sec. 1751.111. (A)(1) This section applies to both of the following:
(a) A health insuring corporation that issues or requires the use of a standardized identification card or an electronic technology for submission and routing of prescription drug claims pursuant to a policy, contract, or agreement for health care services;
(b) A person or entity that a health insuring corporation contracts with to issue a standardized identification card or an electronic technology described in division (A)(1)(a) of this section.
(2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or required use of a standardized identification card or an electronic technology for submission and routing of prescription drug claims in connection with any of the following: (a) Coverage provided under the medicare advantage program operated pursuant to Part C of Title XVIII of the "Social Security Act," 49 Stat. 62 (1935), 42 U.S.C. 301, as amended. (b) Coverage provided under medicaid, as defined in section 5111.01 of the Revised Code. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of this section to the plan and its administrators.
(B) A standardized identification card or an electronic technology issued or required to be used as provided in
division (A)(1) of this section shall
contain uniform prescription
drug information in accordance with either division
(B)(1) or (2) of this section.
(1) The standardized identification card or the electronic technology shall be in a format and
contain information fields approved by the national council for
prescription drug programs or a successor organization, as specified in the council's or successor organization's pharmacy
identification card implementation guide in effect on the first
day of October most immediately preceding the issuance or required use of the standardized identification
card or the electronic technology.
(2) If the health insuring corporation or the person under contract with the corporation to issue a standardized identification card or an electronic technology requires the information for the submission and routing of a claim, the standardized identification card or the electronic technology shall contain any of the
following information:
(a) The health insuring corporation's name;
(b) The subscriber's name, group number, and identification
number;
(c) A telephone number to inquire about pharmacy-related issues;
(d) The issuer's international identification number, labeled as "ANSI BIN" or "RxBIN"; (e) The processor's control number, labeled as "RxPCN";
(f) The subscriber's pharmacy benefits group number if
different from the subscriber's medical group number, labeled as
"RxGrp."
(C) If the standardized identification card or the electronic technology issued or required to be used as provided in division (A)(1) of this section is also used for submission and routing of nonpharmacy
claims, the designation "Rx" is required to be included as part of the labels identified in divisions (B)(2)(d) and (e) of this section if the issuer's international identification number or the processor's control number is different for medical and pharmacy claims.
(D) Each health insuring corporation described in division (A) of this section shall annually file a certificate with the superintendent of insurance certifying that it or any person it contracts with to issue a standardized identification card or electronic technology for submission and routing of prescription drug claims complies with this section.
(E)(1) Except as provided in division (E)(2) of this section, if there is a change in the information contained in the standardized identification card or the electronic technology issued to a subscriber, the health insuring corporation or person under contract with the corporation to issue a standardized identification card or an electronic technology shall issue a new card or electronic technology to the subscriber. (2) A health insuring corporation or person under contract with the corporation is not required under division (E)(1) of this section to issue a new card or electronic technology to a subscriber more than once during a twelve-month
period.
(F) Nothing in this section shall be construed as requiring a health insuring corporation to produce more than one standardized identification card or one electronic technology for use by subscribers accessing health care benefits provided under a policy, contract, or agreement for health care services.
Sec. 3917.01. (A) Group life insurance is that form of
life insurance covering not less than ten two employees with or
without medical examination, written under a policy issued to the
employer, or to a trustee of a trust created by such employer,
the premium on which is to be paid by the employer, by the
employer and employees jointly, or by such trustee out of funds
contributed by the employer or by the employer and employees
jointly, and insuring only all of the employer's employees
or all of any
classes thereof, determined by sex, age, or conditions pertaining
to the employment, for amounts of insurance based upon some plan
which will preclude individual selection, for the benefit of
persons other than the employer; but when the premium is to be
paid by the employer and employee jointly and the benefits of the
policy are offered to all eligible employees, not less than
seventy-five per cent of such employees may be so insured. Such
group policy may provide that "employees" includes retired
employees of the employer and the officers, managers, employees,
and retired employees of subsidiary or affiliated corporations
and the individual proprietors, partners, employees, and retired
employees of affiliated individuals and firms, when the business
of such subsidiary or affiliated corporations, firms, or
individuals is controlled by the common employer through stock
ownership, contract, or otherwise. This section does not define
as a group the lives covered by a policy issued on more than one
life which provides for payments upon the death of any one or
more or upon the death of each of the lives so insured, and upon
which the premium rates charged are computed on the same basis as
used by the issuing company on single life policies and upon its
regular forms of insurance. (B) As used in sections 3917.01 to 3917.06 of the Revised
Code, the following forms of life insurance are group life
insurance: (1) Life insurance covering the members of one or more
companies, batteries, troops, battalions, divisions, or other
units of the national guard or naval militia of any state,
written under a policy issued to the commanding general of the
national guard or commanding officer of the naval militia, who is
the employer for the purposes of such sections, the premium on
which is to be paid by the members of such units for the benefit
of persons other than the employer; provided that when the
benefits of the policy are offered to all eligible members of a
unit of the national guard or naval militia, not less than
seventy-five per cent of the members of such a unit may be
insured; (2) Life insurance covering the members of one or more
troops or other units of the state troopers or state police of
any state, written under a policy issued to the commanding
officer of the state troopers or state police who is the employer
for the purposes of such sections, the premium on which is to be
paid by the members of such units for the benefit of persons
other than the employer; provided that when the benefits of the
policy are offered to all eligible members of a unit of the state
troopers or state police, not less than seventy-five per cent of
the members of such a unit may be insured; (3) Life insurance covering the members of any labor
union, written under a policy issued to such union which is the
employer for the purposes of such sections, the premium on which
is to be paid by the union or by the union and its members
jointly, and insuring only all of its members, who are actively
engaged in the same occupation, for amounts of insurance based
upon some plan which will preclude individual selection, for the
benefit of persons other than the union or its officials;
provided that in case the insurance policy is cancellable at the
end of any policy year at the option of the insurance company and
that the basis of premium rates may be changed by the insurance
company at the beginning of any policy year, all members of a
labor union may be insured; and provided that when the premium is
to be paid by the union and its members jointly and the benefits
are offered to all eligible members, not less than seventy-five
per cent of such members may be insured; and provided that when
members apply and pay for additional amounts of insurance, a
smaller percentage of members may be insured for such additional
amounts if they pass satisfactory medical examinations or submit
satisfactory evidence of insurability; (4) Life insurance written under a policy issued to a
creditor, who shall be deemed the policyholder, to insure debtors
of the creditor, subject to the following requirements: (a) The debtors eligible for insurance under the policy
shall be all of the debtors of the creditor, excepting that no debtor is
eligible
unless
the indebtedness constitutes an obligation to repay that
is binding upon the debtor during the
debtor's lifetime at and from the date the insurance becomes effective
upon the debtor's life. The policy may provide that
"debtors" includes the debtors of one or more subsidiary corporations and the
debtors of one or more affiliated corporations, proprietors, or partnerships
if the business of the
policyholder and of such affiliated corporations, proprietors, or
partnerships is under common control through stock ownership,
contract, or otherwise. (b) The premium for the policy shall be paid by the
policyholder, either from the creditor's funds, or from charges
collected from the insured debtors, or from both. A policy on
which part or all of the premium is to be derived from the
collection from the insured debtors of identifiable charges not
required of uninsured debtors shall not include debtors under
obligations outstanding at its date of issue without evidence of
individual insurability unless at least seventy-five per cent of
the then eligible debtors elect to pay the required charges. A
policy on which no part of the premium is to be derived from the
collection of such identifiable charges must insure all eligible
debtors, or all except any as to whom evidence of individual
insurability is not satisfactory to the insurer. (c) The policy may be issued only if the group of eligible
debtors is then receiving new entrants at the rate of at least
one hundred persons yearly, or may reasonably be expected to
receive at least one hundred new entrants during the first policy
year, and continues to receive not less than one hundred new
entrants to the group yearly, and only if the policy reserves to
the insurer the right to require evidence of individual
insurability if less than seventy-five per cent of the new
entrants become insured. The policy may exclude from the classes
eligible for insurance classes of debtors determined by age. (d) The amount of insurance on the life of any debtor may
be determined by the age of the debtor based upon a plan which
will preclude individual selection and shall at no time exceed
the amount owed by the debtor that is repayable in
installments to the creditor. (e) The insurance shall be payable to the policyholder.
Such payment shall reduce or extinguish the unpaid indebtedness
of the debtor to the extent of such payment. (5) Life insurance covering the members of any duly
organized corporation or association of veterans or veteran
society or association of the World War veterans, written under a
policy issued to such corporation, association, or society which
is the employer for the purpose of such sections, the premium on
which is to be paid by the corporation, association, society, and
its members jointly, and insuring all of its members who are
actively engaged in any occupation for amounts of insurance based
upon some plan which will preclude individual selection for the
benefit of persons other than the corporation, association, or
society or its officials; provided that when the premium is to be
paid by the corporation, association, or society and its members
jointly and the benefits are offered to all eligible members, not
less than seventy-five per cent of such members may be insured;
and provided that when members apply and pay for additional
amounts of insurance, a smaller percentage of members may be
insured for such additional amounts if they pass satisfactory
medical examinations or submit satisfactory evidence of
insurability; (6) Life insurance covering the members of any
organization of agriculturists or horticulturists organized under
the co-operative laws of this state, written under a policy
issued to such co-operative association which is the employer for
the purpose of such sections, the premium on which is to be paid
by the association or by the association and its members jointly,
and insuring all of its members who are actively engaged in
agricultural or horticultural pursuits, for an amount of
insurance based upon some plan which will preclude individual
selection, and for the benefit of persons other than the
association or its officials; provided that when the premium is
to be paid by the corporation, association, or society and its
members jointly and the benefits are offered to all eligible
members, not less than seventy-five per cent of such members may
be insured; provided that when members apply and pay for
additional amounts of insurance, a smaller percentage of members
may be insured for such additional amounts if they pass
satisfactory medical examinations or submit satisfactory evidence
of insurability; (7) Life insurance covering employees of a political
subdivision or district of this state, or of an educational or
other institution supported in whole or in part by public funds,
or of any classes thereof, determined by conditions pertaining to
employment, or of this state or any department or division
thereof, written under a policy issued to such political
subdivision, district, or institution, or the proper official or
board of this state or of such state department or division
thereof, which is the employer for the purpose of such sections,
the premium on which is to be paid by such employees, unless
otherwise provided by law, charter, or ordinance, for the benefit
of persons other than the employer; provided that when the
benefits of the policy are offered to all eligible employees of a
political subdivision or district of the state or of an
educational or other institution supported in whole, or in part
by public funds, or of this state or a state department or
division thereof, not less than seventy-five per cent of such
employees may be insured; and provided that when employees apply
and pay for additional amounts of insurance, a smaller percentage
of employees may be insured for such additional amounts if they
pass satisfactory medical examinations or submit satisfactory
evidence of insurability; and provided that upon acquisition by a
political subdivision of any privately owned property or
enterprise, the employees of which have been covered by a group
policy of life or other insurance as employees of such private
employer, such political subdivision and insurance company may
continue such contract in force upon similar conditions as the
last preceding private employer; (8) Life insurance covering the members, or the members
and the employees of members of any duly organized association,
other than an association subject to any other provision of this
division, written under a policy issued to such association,
which association is the employer for the purpose of such
sections, the premium on which is to be paid by the insured
members or their employees, insuring members and their employees
for amounts of insurance based upon some plan which will preclude
individual selection except as provided in this section, for the
benefit of persons other than the association; provided the
association has been in existence for at least two years
immediately preceding the purchase of the insurance; provided
that there must be at least fifty insured members in any group;
and provided that the association has been organized and is
maintained in good faith for purposes other than that of
obtaining insurance; (9) Life insurance issued to trustees of a trust fund
established jointly by one or more employers in the same
industry, on the one hand, and one or more labor unions
representing as bargaining agents employees of such employers, on
the other hand, or by two or more employers in the same industry,
or by two or more labor unions, which trustees shall be deemed
the policyholder to insure employees of the employers or members
of unions for the benefit of persons other than the employers or
the unions or the trustees, subject to the following
requirements: (a) The persons eligible for such insurance shall be all
of the employees of the employers, or all of the members of the
unions, or all of any class of such employees determined by sex,
age, or conditions pertaining to their employment, or to
membership in the unions, or to any or all of them. The policy
may provide that "employees" includes the retired employees of
the employer and the officers, managers, employees, and retired
employees of subsidiary or affiliated corporations and the
individual proprietors, partners, employees, and retired
employees of affiliated individuals and firms, when the business
of such subsidiary or affiliated corporations, firms, or
individuals is controlled by the common employer through stock
ownership, contract, or otherwise. The policy may provide that
"employees" includes the individual proprietor or partners if the
employer is an individual proprietor or a partnership. The policy
may provide that "employees" includes the trustees or their
employees, or both, if their duties are principally connected
with such trusteeship. (b) The premium for the policy shall be paid by the
trustees, either wholly from funds contributed by the employers
of the insured persons, or partly from such funds and partly from
funds contributed by the insured employees. If part of the
premium is to be derived from funds contributed by the insured
employees, then such policy may be placed in force only if it
covers at least seventy-five per cent of the then eligible
employees. A policy on which no part of the premium is derived
from funds contributed by the insured employees must insure all
eligible employees. (c) Any policy must insure at least ten two persons at date of
issue. (d) The amounts of insurance under the policy must be
based upon some plan precluding individual selection by the
insured persons or the policyholder or the employers or the
unions or the trustees. (10) Life insurance covering the members of a credit
union, which shall be deemed to be the employer for the purposes
of this section, the premium on which is to be paid by the credit
union or by the credit union and its members jointly, and
insuring all of its eligible members for amounts of insurance not
in excess of the share balance as to each member, and for the
benefit of persons other than the credit union or its officers;
provided that in the determination of the eligibility of members
there may be classifications and limitations based upon age;
provided also that when the premium is to be paid by the credit
union and its members jointly and the benefits are offered to all
eligible members, not less than seventy-five per cent of such
members may be so insured; provided also that in obtaining such
insurance, the officers of the credit union shall consider
proposals from any licensed insurer; provided also that members
may be required to provide evidence of insurability satisfactory
to the insurer. (11) Life insurance covering the members of any duly
organized corporation or association of members of the Ohio
national guard, the Ohio naval militia, and the Ohio military
reserve, which shall have been in existence for at least two
years immediately preceding the purchase of such insurance,
written under a policy issued to such corporation or association,
which corporation or association is the employer for the purpose
of such sections, the premium on which is to be paid by the
insured members, insuring members for amounts of insurance based
upon some plan which will preclude individual selection, except
as provided in this section, for the benefit of persons other
than the corporation or association, provided that there must be
at least fifty insured members in any group, and provided further
that unless seventy-five per cent of all members or one thousand
members, whichever is the lesser number, are insured, each member
must pass a satisfactory medical examination in order to be
insured; and provided that, when members apply and pay for
additional amounts of insurance, they may be insured for such
additional amounts if they pass satisfactory medical examinations
or submit satisfactory evidence of insurability. (12) Life insurance that is written under a policy
issued to a trustee under a trust established by an insurer for
the purpose of providing continued group life insurance coverage
to those former employees,
former members, or former members and the employees of such members, and their
spouses and dependent children,
previously covered under policies of group life insurance issued
by the insurer to employers or trustees pursuant to
division (A) of this section, to associations pursuant to division
(B)(8) of this section, or to trustees pursuant to division
(B)(9) of this section, and
that is evidenced by the issuance of a certificate of insurance
to such former employees or members; provided that the amount of the continued
life
insurance coverage made available to a former employee or member and to
the employee's or member's spouse and dependents shall not exceed the amount
of the group life insurance coverage previously provided to
the employee or member and the employee's or member's eligible dependents at
the time
of the
employee's separation from employment or the member's termination of
membership. (13) Life insurance covering the members of a workforce actively engaged in an occupation for, and performing services on behalf of, a duly organized corporation, limited liability company, partnership, proprietor, or similar organization, whose members are not employees of the organization, written under a policy issued to the organization, which organization is the members' employer for this purpose, the premium on which is to be paid by the organization or by the organization and the members jointly, insuring members for amounts of insurance based upon some plan which will preclude individual selection, for the benefit of persons other than the organization; provided, that when the premium is to be paid by the organization and its members jointly and the benefits are offered to all eligible members, not less than seventy-five per cent of the members may be so insured; provided also that members may be required to furnish evidence of insurability satisfactory to the insurer. Life insurance meeting this definition may also cover the organization's employees at the option of the organization. (C) Any policy issued pursuant to this section, except a
policy issued to a creditor pursuant to division (B)(4) of this
section, may be extended, in the form of group term life
insurance only, to insure the spouse and dependent children of an
insured employee or member, or any class or classes thereof,
subject to the following requirements: (1) The premiums for the group term life insurance shall
be paid by the policyholder, either from the employer, union or
association funds, or from funds contributed by the employer,
union, or association, or from funds contributed by the insured
employee or member, or from both. (2) The amounts of insurance under the policy must be
based upon some plan precluding individual selection either by
the insured employee or member or by the policyholder. (3) Upon termination of the group term life insurance with
respect to the spouse of any insured employee or member by reason
of such person's termination of employment or membership or
death, the spouse insured pursuant to this section shall have the
same conversion rights as to the group term life insurance on the
spouse's life as is provided for the insured employee or
member. (4) Only one certificate need be issued for delivery to an
insured employee or member if a statement concerning any
dependent's coverage is included in such certificate.
Sec. 3923.601. (A)(1) This section applies to both of the following: (a) A sickness and accident insurer that issues or requires the use of a standardized identification card or an electronic technology for submission and routing of prescription drug claims pursuant to a policy, contract, or agreement for health care services;
(b) A person that a sickness and accident insurer contracts with to issue a standardized identification card or an electronic technology described in division (A)(1)(a) of this section. (2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or required use of a
standardized identification card or an electronic
technology for the submission and routing of prescription drug claims in connection with any of the following: (a) Any individual or group policy of
sickness and accident insurance covering only accident, credit,
dental, disability income, long-term care, hospital indemnity,
medicare supplement, medicare, tricare, specified disease, or
vision care; coverage under a one-time-limited-duration policy of
not longer than six months; coverage issued as a supplement to
liability insurance; insurance arising out of workers'
compensation or similar law; automobile medical payment insurance;
or insurance under which benefits are payable with or without
regard to fault and which is statutorily required to be contained
in any liability insurance policy or equivalent self-insurance. (b) Coverage provided under medicaid, as defined in section 5111.01 of the Revised Code. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of this section to the plan and its administrators. (B) A standardized identification card or an electronic
technology issued or required to be used as
provided in division (A)(1) of this section shall contain uniform
prescription drug information in accordance with
either division (B)(1) or (2) of this section.
(1) The standardized identification card or the electronic technology shall be in a format and
contain information fields approved by the national council for
prescription drug programs or a successor organization, as specified in the council's or successor organization's pharmacy
identification card implementation guide in effect on the first
day of October most immediately preceding the issuance or required use of the standardized identification card or the electronic technology.
(2) If the insurer or person under contract with the insurer to issue a standardized identification card or an electronic technology requires the information for the submission and routing of a claim, the standardized identification card or the electronic technology shall contain any of the
following information:
(a) The insurer's name;
(b) The insured's name, group number, and identification
number; (c) A telephone number to inquire about pharmacy-related issues;
(d) The issuer's international identification number, labeled as "ANSI BIN" or "RxBIN";
(e) The processor's control number, labeled as "RxPCN";
(f) The insured's pharmacy benefits group number if
different from the insured's medical group number, labeled as
"RxGrp."
(C) If the standardized identification card or the electronic technology issued or required to be used as provided in division (A)(1) of this section is also used for submission and routing of nonpharmacy
claims, the designation "Rx" is required to be included as part of the labels identified in divisions (B)(2)(d) and
(e) of this section if the issuer's international identification number or the processor's control number is different for medical and pharmacy claims.
(D) Each sickness and accident insurer described in division (A) of this section shall annually file a certificate with the superintendent of insurance certifying that it or any person it contracts with to issue a standardized identification card or electronic technology for submission and routing of prescription drug claims complies with this section. (E)(1) Except as provided in division (E)(2) of this section, if there is a change in the information contained in the standardized identification card or the electronic technology issued to an insured, the insurer or person under contract with the insurer to issue a standardized identification card or an electronic technology shall issue a new card or electronic technology to the insured.
(2) An insurer or person under contract with the insurer is not required under division (E)(1) of this section to issue a new card or electronic technology
to an
insured more than once during a twelve-month period.
(F) Nothing in this section shall be construed as requiring an insurer to produce more than one standardized identification card or one electronic technology for use by insureds accessing health care benefits provided under a policy of sickness and accident insurance.
Sec. 3923.83. (A)(1) This section applies to both of the following: (a) A public employee benefit plan that issues or requires the use of a standardized identification card or an electronic technology for submission and routing of prescription drug claims pursuant to a policy, contract, or agreement for health care services;
(b) A person or entity that a public employee benefit plan contracts with to issue a standardized identification card or an electronic technology described in division (A)(1)(a) of this section. (2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or required use of a
standardized identification card or an electronic
technology for the submission and routing of prescription drug claims in connection with either of the following: (a) Any individual or group policy of insurance covering only accident, credit,
dental, disability income, long-term care, hospital indemnity,
medicare supplement, medicare, tricare, specified disease, or
vision care; coverage under a one-time-limited-duration policy of
not longer than six months; coverage issued as a supplement to
liability insurance; insurance arising out of workers'
compensation or similar law; automobile medical payment insurance;
or insurance under which benefits are payable with or without
regard to fault and which is statutorily required to be contained
in any liability insurance policy or equivalent self-insurance. (b) Coverage provided under medicaid, as defined in section 5111.01 of the Revised Code. (B) A standardized identification card or an electronic
technology issued or required to be used as
provided in division (A)(1) of this section shall contain uniform
prescription drug information in accordance with
either division (B)(1) or (2) of this section.
(1) The standardized identification card or the electronic technology shall be in a format and
contain information fields approved by the national council for
prescription drug programs or a successor organization, as specified in the council's or successor organization's pharmacy
identification card implementation guide in effect on the first
day of October most immediately preceding the issuance or required use of the standardized identification card or the electronic technology.
(2) If the public employee benefit plan or person under contract with the plan to issue a standardized identification card or an electronic technology requires the information for the submission and routing of a claim, the standardized identification card or the electronic technology shall contain any of the
following information:
(a) The plan's name;
(b) The insured's name, group number, and identification
number; (c) A telephone number to inquire about pharmacy-related issues;
(d) The issuer's international identification number, labeled as "ANSI BIN" or "RxBIN";
(e) The processor's control number, labeled as "RxPCN";
(f) The insured's pharmacy benefits group number if
different from the insured's medical group number, labeled as
"RxGrp."
(C) If the standardized identification card or the electronic technology issued or required to be used as provided in division (A)(1) of this section is also used for submission and routing of nonpharmacy
claims, the designation "Rx" is required to be included as part of the labels identified in divisions (B)(2)(d) and
(e) of this section if the issuer's international identification number or the processor's control number is different for medical and pharmacy claims.
(D)(1) Except as provided in division (D)(2) of this section, if there is a change in the information contained in the standardized identification card or the electronic technology issued to an insured, the public employee benefit plan or person under contract with the plan to issue a standardized identification card or electronic technology shall issue a new card or electronic technology to the insured.
(2) A public employee benefit plan or person under contract with the plan is not required under division (D)(1) of this section to issue a new card or electronic technology
to an
insured more than once during a twelve-month period.
(F) Nothing in this section shall be construed as requiring a public employee benefit plan to produce more than one standardized identification card or one electronic technology for use by insureds accessing health care benefits provided under a health benefit plan.
SECTION 2. That existing section 3917.01 of the Revised Code is hereby repealed.
SECTION 3. Sections 1739.061, 1751.111, 3923.601, and 3923.83 of the Revised Code, as enacted by this act shall
take effect one year
after the effective date of this act.
SECTION 4. (A) Section 1739.061 of the Revised Code, as enacted by this act, shall apply only with respect to multiple employer welfare arrangements authorized to enter into a program or arrangement in this state on or after one year after the effective date of Section 1 of this act. (B)
Section 1751.111 of the Revised Code, as enacted by this act, shall apply only with respect to policies, contracts, and agreements delivered, issued for delivery, or renewed in this state on or after one year after the effective date of Section 1 of this act.
(C) Section 3923.601 of the Revised Code, as enacted by this act, shall apply only with respect to policies of sickness and accident insurance delivered, issued for delivery, renewed, or used in this state on or after one year after the effective date of Section 1 of this act. (D) Section 3923.80 of the Revised Code, as enacted by this act, shall apply only with respect to public employee benefit plans established or modified by this state on or after one year after the effective date of Section 1 of this act.
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