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S. B. No. 75 As IntroducedAs Introduced
130th General Assembly | Regular Session | 2013-2014 |
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Cosponsors:
Senators Seitz, Brown
A BILL
To amend section 1739.05 and to enact sections
1751.76, 3923.71, and 3923.74 of the Revised Code
to prohibit health insurers from denying payment
for a service during or after the performance of
the service if the insurer provided prior written
authorization for the service.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 1739.05 be amended and sections
1751.76, 3923.71, and 3923.74 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,
3923.74, 3923.80, 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. 1751.76. No health insuring corporation that agrees in
writing to provide coverage for the performance of a service prior
to the performance of the service shall deny payment for the
service during or after the performance of the service unless the
health insuring corporation's written agreement to provide
coverage for the service was based upon inaccurate information
provided to the health insuring corporation by the enrollee or
health care provider.
Sec. 3923.71. No sickness and accident insurer that agrees
in writing to provide coverage for the performance of a service
prior to the performance of the service shall deny payment for the
service during or after the performance of the service unless the
insurer's written agreement to provide coverage for the service
was based upon inaccurate information provided to the insurer by
the insured or the health care provider.
Sec. 3923.74. No public employee benefit plan that agrees in
writing to provide coverage for the performance of a service prior
to the performance of the service shall deny payment for the
service during or after the performance of the service unless the
public employee benefit plan's written agreement to provide
coverage for the service was based upon inaccurate information
provided to the public employee benefit plan by the plan member,
covered dependent, or health care provider.
Section 2. That existing section 1739.05 of the Revised Code
is hereby repealed.
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