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H. B. No. 237 As IntroducedAs Introduced
128th General Assembly | Regular Session | 2009-2010 |
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Cosponsors:
Representatives Fende, Weddington, Hagan, Harwood, Boyd, Phillips, Domenick, Letson, Moran, Yuko, Winburn, Luckie, Harris, Bolon
A BILL
To amend section 1739.05 and to enact sections
1751.68, 1751.69, 3923.84, and 3923.85, of the
Revised
Code regarding health insurance coverage
for orally administered cancer
medications and
the procedures insured persons are required or
permitted to use in acquiring certain
non-self-injectable and
compounded medications.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 1739.05 be
amended and
sections
1751.68, 1751.69, 3923.84, and 3923.85 of the Revised Code be
enacted to read as
follows:
Sec. 1739.05. (A) A multiple employer welfare arrangement
that is created pursuant to sections 1739.01 to 1739.22 of the
Revised Code and that operates a group self-insurance program may
be established only if any of the following applies:
(1) The arrangement has and maintains a minimum enrollment
of
three hundred employees of two or more employers.
(2) The arrangement has and maintains a minimum enrollment
of
three hundred self-employed individuals.
(3) The arrangement has and maintains a minimum enrollment
of
three hundred employees or self-employed individuals in any
combination of divisions (A)(1) and (2) of this section.
(B) A multiple employer welfare arrangement that is
created
pursuant to sections 1739.01 to 1739.22 of the Revised
Code and
that operates a group self-insurance program shall
comply with all
laws applicable to self-funded programs in this
state, including
sections 3901.04, 3901.041, 3901.19 to 3901.26,
3901.38, 3901.381
to
3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to
3902.14,
3923.282,
3923.30,
3923.301, 3923.38,
3923.581, 3923.63, 3923.80,
3923.84, 3923.85,
3924.031,
3924.032,
and
3924.27
of the Revised
Code.
(C) A multiple employer welfare arrangement created
pursuant
to sections 1739.01 to 1739.22 of the Revised Code shall
solicit
enrollments only through agents or solicitors licensed
pursuant to
Chapter 3905. of the Revised Code to sell or solicit
sickness and
accident insurance.
(D) A multiple employer welfare arrangement created
pursuant
to sections 1739.01 to 1739.22 of the Revised Code shall
provide
benefits only to individuals who are members, employees
of
members, or the dependents of members or employees, or are
eligible for continuation of coverage under section 1751.53 or
3923.38 of the Revised Code or under Title X of the "Consolidated
Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29
U.S.C.A. 1161, as amended.
Sec. 1751.68. (A) Notwithstanding section 3901.71 of the
Revised Code and subject to division (B) of this section, no
individual or group health insuring corporation policy, contract,
or agreement providing basic health care services or prescription
drug services that is delivered, issued for delivery, or renewed
in this state on or after the effective date of this section and
that provides coverage for cancer chemotherapy treatment shall
provide coverage for a prescribed, orally administered cancer
medication on a less favorable basis than coverage for
intravenously administered or injected cancer medications.
(B) The prohibition in division (A) of this section includes
a prohibition on imposing a coverage limit, copayment, or
deductible that is greater, or a prior authorization requirement
that is more stringent, than any coverage limit, copayment,
deductible, or prior authorization requirement in the policy,
contract, or agreement that applies to coverage for intravenously
administered or injected cancer medications.
Sec. 1751.69. (A) As used in this section:
(1) "Dangerous drug" and "pharmacy" have
the same meanings
as in section 4729.01 of the Revised Code.
(2) "Non-self-injectable medication" means a dangerous drug
intended for administration by injection that an individual cannot
reasonably self-administer.
(3) "Retail seller" has the same meaning as in section
4729.01 of the Revised Code, and includes a specialty pharmacy or
mail order pharmacy.
(B) No individual or group health insuring corporation
policy, contract, or agreement providing basic health care
services or prescription drug services that is delivered, issued
for delivery, or renewed in this state on or after the effective
date of this section and that provides coverage for
non-self-injectable medications, medications that must be
compounded immediately prior to administration, or both, shall do
either of
the following:
(1) Require an enrollee to take possession of such a
medication from a
pharmacy that is a retail seller;
(2) Give an enrollee the option of having such a medication
delivered directly to the enrollee by mail or any means of
commercial shipment.
Sec. 3923.84. (A) Notwithstanding section 3901.71 of the
Revised Code and subject to division (B) of this section, neither
of the following that provides coverage for cancer chemotherapy
treatment shall provide coverage for a prescribed, orally
administered cancer medication on a less favorable basis than for
intravenously administered or injected cancer medications:
(1) An individual or group policy of sickness and accident
insurance that is delivered, issued for delivery, or renewed in
this state on or after the effective date of this section;
(2) A public employee benefit plan that is established or
modified in this state on or after the effective date of this
section.
(B) The prohibition in division (A) of this section includes
a prohibition on imposing a coverage limit, copayment, or
deductible that is greater, or a prior authorization requirement
that is more stringent, than any coverage limit, copayment,
deductible, or prior authorization requirement in the policy or
plan that applies to coverage for intravenously administered or
injected cancer medications.
Sec. 3923.85. (A) As used in this section:
(1) "Dangerous drug" and "pharmacy" have
the same meanings
as in section 4729.01 of the Revised Code.
(2) "Non-self-injectable medication" means a dangerous drug
intended for administration by injection that an individual cannot
reasonably self-administer.
(3) "Retail seller" has the same meaning as in section
4729.01 of the Revised Code, and includes a specialty pharmacy or
mail order pharmacy.
(B) Neither of the following that provides coverage for
non-self-injectable medications, medications that must be
compounded immediately prior to administration, or both, shall
require an
insured to take possession of such a medication from a
pharmacy that is a
retail seller or give an insured the option of
having such a medication delivered directly to the insured by mail
or any means of commercial shipment:
(1) An individual or group policy of sickness and accident
insurance that is delivered, issued for delivery, or renewed in
this state on or after the effective date of this section;
(2) A public employee benefit plan that is established or
modified in this state on or after the effective date of this
section.
Section 2. That existing section 1739.05 of the Revised Code
is hereby repealed.
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