To amend section 1739.05 and to enact sections 1751.69 and 3923.85 of the Revised Code to require health insurers to provide coverage for prostheses.

Section 1.  That section 1739.05 be amended and sections 1751.69 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, 3923.24, 3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, 3923.80, 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. 1751.69. (A) As used in this section, "prosthesis" means an artificial leg, arm, or eye, including a replacement if required because of a change in the patient's physical condition.

(B) Notwithstanding section 3901.71 of the Revised Code and except as provided in division (D) of this section, each individual or group health insuring corporation policy, contract, or agreement providing basic health care services that is delivered, issued for delivery, or renewed in this state shall provide coverage for benefits for prostheses that are medically necessary. In providing the coverage, all of the following apply:

(1) The coverage shall be at least equal to the coverage provided under the medicare program pursuant to Title XVIII of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as amended.

(2) The coverage shall include coverage for benefits for the repair or replacement of a prosthesis that is medically necessary.

(3) The policy, contract, or agreement may require prior authorization for a prosthesis using the same prior authorization process that is used for other covered benefits.

(4) The policy, contract, or agreement may impose a deductible, copayment, coinsurance, or any combination thereof, on a prosthesis. The amount imposed shall not exceed the amount of the respective deductible, copayment, coinsurance, or combination thereof, that is imposed for other health benefits under the policy, contract, or agreement.

(5) The policy, contract, or agreement shall provide reimbursement for a prosthesis in an amount equal to the fee schedule amount for the prosthesis under the medicare reimbursement schedule.

(6) The policy, contract, or agreement shall not impose any annual or lifetime dollar maximum on the coverage for prostheses, other than an annual or lifetime dollar maximum that applies in the aggregate to all terms and services covered under the policy, contract, or agreement.

(C) Nothing in division (B) of this section requires a policy, contract, or agreement to provide reimbursement to a health care provider or facility for providing, repairing, or replacing prostheses if the provider or facility does not have a health care contract with the health insuring corporation.

(D) Division (B) of this section does not apply to a contract that a health insuring corporation enters into with the department of job and family services under section 5111.17 of the Revised Code.

Sec. 3923.85. (A) As used in this section, "prosthesis" means an artificial leg, arm, or eye, including a replacement if required because of a change in the patient's physical condition.

(B) Notwithstanding section 3901.71 of the Revised Code and except as provided in division (D) of this section, each individual or group policy of sickness and accident insurance that is delivered, issued for delivery, or renewed in this state and each public employee benefit plan that is established or modified in this state shall provide coverage for benefits for prostheses that are medically necessary. In providing the coverage, all of the following apply:

(1) The coverage shall be at least equal to the coverage provided under the medicare program pursuant to Title XVIII of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C. 1395, as amended.

(2) The coverage shall include coverage for benefits for the repair or replacement of a prosthesis that is medically necessary.

(3) The policy or plan may require prior authorization for a prosthesis using the same prior authorization process that is used for other covered benefits.

(4) The policy or plan may impose a deductible, copayment, coinsurance, or any combination thereof, on a prosthesis. The amount imposed shall not exceed the amount of the respective deductible, copayment, coinsurance, or combination thereof, that is imposed for other health benefits under the policy or plan.

(5) The policy or plan shall provide reimbursement for a prosthesis in an amount equal to the fee schedule amount for the prosthesis under the medicare reimbursement schedule.

(6) The policy or plan shall not impose any annual or lifetime dollar maximum on the coverage for prostheses, other than an annual or lifetime dollar maximum that applies in the aggregate to all terms and services covered under the policy or plan.

(C) Nothing in division (B) of this section requires a policy or plan to provide reimbursement to a health care provider or facility for providing, repairing, or replacing prostheses if the provider or facility does not have a health care contract with the sickness and accident insurer or public employee benefit plan.

(D) Division (B) of this section does not apply to the offer or renewal of any individual or group policy of sickness and accident insurance that provides coverage for specific diseases or accidents only, or to any hospital indemnity, medicare supplement, medicare, tricare, long-term care, disability income, one-time limited duration policy of not longer than six months, or other policy that offers only supplemental benefits.

Section 2. That existing section 1739.05 of the Revised Code is hereby repealed.

Section 3. Section 1751.69 of the Revised Code shall apply only to policies, contracts, and agreements that are delivered, issued for delivery, or renewed in this state on or after the effective date of this act. Section 3923.85 of the Revised Code shall apply to policies of sickness and accident insurance on or after the effective date of this act in accordance with section 3923.01 of the Revised Code and to public employee benefit plans that are established or modified in this state on or after the effective date of this act.