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S. B. No. 54 As IntroducedAs Introduced
127th General Assembly | Regular Session | 2007-2008 |
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Cosponsor:
Senator Schuler
A BILL
To amend section 3923.05 and to enact section 3923.80 of the Revised Code to prohibit certain insurers from limiting or excluding coverage for injuries occurring as a consequence of an insured's use of alcohol or other drugs or both.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 3923.05 be amended and section 3923.80 be enacted to read as follows:
Sec. 3923.05. Except as provided in section 3923.07 of the
Revised Code, no policy of sickness and accident insurance
delivered, issued for delivery, or used in this state shall
contain provisions respecting the matters set forth in this
section unless such provisions are in the words in which the same
appear in this section. Any such provisions in any such policy
shall be preceded by the appropriate caption appearing in this
section or, at the option of the insurer, by such appropriate
individual or group captions or subcaptions as the superintendent
of insurance may approve. (A) A provision as follows: Change of occupation. If the
insured be injured or contract sickness after having changed his the
insured's
occupation to one classified by the insurer as more hazardous
than that stated in this policy or while doing for compensation
anything pertaining to an occupation so classified, the insurer
will pay only such portion of the indemnities provided in this
policy as the premium paid would have purchased at the rates and
within the limits fixed by the insurer for such more hazardous
occupation. If the insured changes his the insured's occupation
to one
classified by the insurer as less hazardous than that stated in
this policy, the insurer, upon receipt of proof of such change of
occupation, will reduce the premium rate accordingly, and will
return the excess pro rata unearned premium from the date of
change of occupation or from the policy anniversary date
immediately preceding receipt of such proof, whichever is the
more recent. In applying this provision, the classification for
occupational risk and the premium rates shall be such as have
been last filed by the insurer prior to the occurrence of the
loss for which the insurer is liable or prior to the date of
proof of change in occupation with the state official having
supervision of insurance in the state where the insured resided
at the time this policy was issued; but if such filing was not
required, then the classification of occupational risk and the
premium rates shall be those last made effective by the insurer
in such state prior to the occurrence of the loss or prior to the
date of proof of change in occupation. (B) A provision as follows: Misstatement of age. If the
age of the insured has been misstated, all amounts payable under
this policy shall be such as the premium paid would have
purchased at the correct age. (C) A provision as follows: (1) Other insurance in this insurer. If an accident or
sickness or accident and sickness policy or policies previously
issued by the insurer to the insured be in force concurrently
herewith, making the aggregate indemnity for ............... in
excess of ......... dollars, the excess insurance shall be void
and all premiums paid for such excess shall be returned to the
insured or to his the insured's estate. The insurer shall insert the type of coverage or coverages
in the first blank space in the provision in division (C)(1) of
this section and the maximum limit of indemnity or indemnities in
the second blank space in the provision in division (C)(1) of
this section. (2) In lieu of the foregoing provision in division (C)(1)
of this section, a provision as follows: Other insurance in this
insurer. Insurance effective at any time on the insured under a
like policy or policies in this insurer is limited to the one
such policy elected by the insured, his the insured's
beneficiary or his the insured's estate, as the case may be, and
the insurer will return all
premiums paid for all other such policies. (D) A provision as follows: Insurance with other
insurers. If there be other valid coverage, not with this
insurer, providing benefits for the same loss on a provision of
service basis or on an expense incurred basis and of which this
insurer has not been given written notice prior to the occurrence
or commencement of loss, the only liability under any expense
incurred coverage of this policy shall be for such proportion of
the loss as the amount which would otherwise have been payable
hereunder plus the total of the like amounts under all such other
valid coverages for the same loss of which this insurer had
notice bears to the total like amounts under all valid coverages
for such loss, and for the return of such portion of the premiums
paid as shall exceed the pro-rata portion for the amount so
determined. For the purpose of applying this provision when
other coverage is on a provision of service basis, the "like
amount" of such other coverage shall be taken as the amount which
the services rendered would have cost in the absence of such
coverage. If the provision in division (D) of this section is
included in a policy of sickness and accident insurance which
also contains the provision in division (E) of this section, the
insurer shall add to the caption of the provision in division (D)
of this section the following: Expense incurred benefits. The insurer may at its option include in the provision in
division (D) of this section a definition of "other valid
coverage" approved as to form by the superintendent. Such
definition shall be limited in subject matter to coverage
provided by organizations subject to regulation by insurance law
or by insurance authorities of this or any other state of the
United States or any province of the Dominion of Canada, and by
hospital or medical service organizations, and to any other
coverage the inclusion of which may be approved by the
superintendent. In the absence of such definition in the
provision in division (D) of this section, "other valid coverage"
as used in such provision shall not include group insurance,
automobile medical payments insurance, or coverage provided by
hospital or medical service organizations or by union welfare
plans or employer or employee benefit organizations. For the purpose of applying the provision in division (D)
of this section with respect to any insured, any amount of
benefit provided for such insured pursuant to any compulsory
benefit statute, including any workers' compensation or
employer's liability statute, whether provided by governmental
agency or otherwise, shall in all cases be deemed to be "other
valid coverage" of which the insurer has had notice. In applying the provision in division (D) of this section
no third party liability coverage shall be included as "other
valid coverage." (E) A provision as follows: Insurance with other
insurers. If there be other valid coverage, not with this
insurer, providing benefits for the same loss on other than an
expense incurred basis and of which the insurer has not been
given written notice prior to the occurrence or commencement of
loss, the only liability for such benefits under this policy
shall be for such proportion of the indemnities otherwise
provided hereunder for such loss as the like indemnities of which
the insurer had notice (including the indemnities under this
policy) bear to the total amount of all like indemnities for such
loss, and for the return of such portion of the premium paid as
shall exceed the pro-rata portion for the indemnities thus
determined. If the provision in division (E) of this section is
included in a policy of sickness and accident insurance which
also contains the provision in division (D) of this section, the
insurer shall add to the caption of the provision in division (E)
of this section the following: Other benefits. The insurer may at its option include in the provision in
division (E) of this section a definition of "other valid
coverage" approved as to form by the superintendent. Such
definition shall be limited in subject matter to coverage
provided by organizations subject to regulation by insurance law
or by insurance authorities of this or any other state of the
United States or any province of the Dominion of Canada, and to
any other coverage the inclusion of which may be approved by the
superintendent. In the absence of such definition in the
provision in division (E) of this section, "other valid coverage"
as used in such provision shall not include group insurance, or
benefits provided by union welfare plans or by employer or
employee benefit organizations. For the purpose of applying the provision in division (E)
of this section with respect to any insured, any amount of
benefit provided for such insured pursuant to any compulsory
benefit statute, including any workers' compensation or
employer's liability statute, whether provided by a governmental
agency or otherwise, shall in all cases be deemed to be "other
valid coverage" of which the insurer has had notice. In applying the provision in division (E) of this section
no third party liability coverage shall be included as "other
valid coverage." (F) A provision as follows: Relation of earnings to
insurance. If the total monthly amount of loss of time benefits
promised for the same loss under all valid loss of time coverage
upon the insured, whether payable on a weekly or monthly basis,
shall exceed the monthly earnings of the insured at the time
disability commenced or his the insured's average monthly
earnings for the
period of two years immediately preceding a disability for which
claim is made, whichever is the greater, the insurer will be
liable only for such proportionate amount of such benefits under
this policy as the amount of such monthly earnings or such
average monthly earnings of the insured bears to the total amount
of monthly benefits for the same loss under all such coverage
upon the insured at the time such disability commences and for
the return of such part of the premiums paid during such two
years as shall exced exceed the pro-rata amount of the premiums
for the benefits actually paid hereunder; this shall not operate
to reduce the total monthly amount of benefits payable under all
such coverage upon the insured below the sum of two hundred
dollars or the sum of the monthly benefits specified in such
coverages, whichever is the lesser, nor shall this operate to
reduce benefits other than those payable for loss of time. The provision in division (F) of this section may be placed
only in a policy of sickness and accident insurance which the
insured has a right to continue in force subject to its terms by
the timely payment of premiums until at least age fifty or in a
policy of sickness and accident insurance issued after the
insured has attained age forty-four and which the insured has the
right to continue in force subject to its terms by the timely
payment of premiums for at least five years from its date of
issue. The insurer may at its option include in the provision in
division (F) of this section a definition of "valid loss of time
coverage" approved as to form by the superintendent. Such
definition shall be limited in subject matter to coverage
provided by governmental agencies or by organizations subject to
regulation by insurance law or by insurance authorities of this
or any other state of the United States or any province of the
Dominion of Canada or to any other coverage the inclusion of
which may be approved by the superintendent or any combination of
such coverages. In the absence of such definition in the
provision in division (F) of this section "valid loss of time
coverage" as used in such provision shall not include any
coverage provided for such insured pursuant to any compulsory
benefit statute, including any workers' compensation or
employer's liability statute, whether provided by a governmental
agency or otherwise, or benefits provided by union welfare plans
or by employer or employee benefit organizations. (G) A provision as follows: Unpaid premium. Upon the
payment of a claim under this policy, any premium then due and
unpaid or covered by any note or written order may be deducted
therefrom. (H) A provision as follows: Conformity with state
statutes. Any provision of this policy which, on its effective
date, is in conflict with the statutes of the state in which the
insured resides on such date is hereby amended to conform to the
minimum requirements of such statutes. (I) A provision as follows: Illegal occupation. The
insurer shall not be liable for any loss to which a contributing
cause was the insured's commission of or attempt to commit a
felony or to which a contributing cause was the insured's being
engaged in an illegal occupation. (J) A provision as follows: Intoxicants and narcotics.
The insurer shall not be liable for any loss sustained or
contracted in consequence of the insured's being intoxicated or
under the influence of any narcotic unless administered on the
advice of a physician.
Sec. 3923.80. (A) Notwithstanding section 3901.71 of the Revised Code, no health benefit plan shall contain a provision that limits or excludes an insured's coverage under the plan for a loss the insured sustains that is the result of the insured's use of alcohol or other drugs or both and the loss is otherwise covered under the plan.
(B) As used in this section:
(1) "Carrier" means any sickness and accident insurance company or health insuring corporation authorized to issue health benefit plans in this state, a public employee benefit plan, or a multiple employer welfare arrangement, as defined in the "Employee Retirement Income Security Act of 1974," 88 Stat. 832, 29 U.S.C. 1002, except for any arrangement which is fully insured as defined in that act at 29 U.S.C. 1144 (b)(6)(d).
(2) "Health benefit plan" means any hospital or medical expense policy or certificate or any health plan provided by a carrier, that is delivered, issued for delivery, renewed, or used in this state on or after the date occurring six months after the effective date of this act. "Health benefit plan" does not include policies covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, 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 a 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.
(3) "Insured" means a person covered by a health benefit plan issued by a carrier.
Section 2. That existing section 3923.05 of the Revised Code is hereby repealed.
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