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Sub. S. B. No. 9 As Reported by the House Insurance CommitteeAs Reported by the House Insurance Committee
130th General Assembly | Regular Session | 2013-2014 |
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Cosponsors:
Senators Beagle, Hite, Jones, Seitz, Widener, Brown, Cafaro, Eklund, Lehner, Manning, Peterson, Smith
Representatives Carney, Hackett
A BILL
To amend section 1751.31 and to suspend sections
1751.15, 1751.16, 1751.17, 3923.122, 3923.58,
3923.581, 3923.582, 3923.59, 3924.07, 3924.08,
3924.09, 3924.10, 3924.11, 3924.111, 3924.12,
3924.13, and 3924.14 of the Revised Code to make
changes to the procedure for submission and review
of a health insuring corporation's solicitation
document, and to suspend the enforcement of the
Ohio Open Enrollment Program, the Ohio Health
Reinsurance Program, and the option for conversion
of a health insurance contract or policy under
certain circumstances during the period beginning
January 1, 2014, and expiring January 1, 2018.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 1751.31 of the Revised Code be
amended to read as follows:
Sec. 1751.31. (A) Any changes in a health insuring
corporation's solicitation document shall be filed with the
superintendent of insurance thirty days prior to use for
informational purposes, and shall comply with the requirements of
this section. The If the superintendent finds that any
solicitation document fails to comply with the requirements of
this section, the superintendent, within sixty days of filing, may
disapprove any solicitation document or require amendment to it on
any of the grounds stated in this section. Such disapproval shall
be effected by written notice to the health insuring corporation.
The notice shall state the grounds for disapproval and shall be
issued in accordance with Chapter 119. of the Revised Code.
(B) The solicitation document shall contain all information
necessary to enable a consumer to make an informed choice as to
whether or not to enroll in the health insuring corporation. The
information shall include a specific description of the health
care services to be available and the approximate number and type
of full-time equivalent medical practitioners. The information
shall be presented in the solicitation document in a manner that
is clear, concise, and intelligible to prospective applicants in
the proposed service area.
(C) Every potential applicant whose subscription to a health
care plan is solicited shall receive, at or before the time of
solicitation, a solicitation document approved by the
superintendent.
(D) Notwithstanding division (A) of this section, a health
insuring corporation may use a solicitation document that the
corporation uses in connection with policies for medicare
beneficiaries pursuant to a medicare risk contract or medicare
cost contract, or for policies for beneficiaries of the federal
employees health benefits program pursuant to 5 U.S.C.A. 8905, or
for policies for medicaid recipients, or for policies for
beneficiaries of any other federal health care program regulated
by a federal regulatory body, or for policies for beneficiaries of
contracts covering officers or employees of the state entered into
by the department of administrative services, if both of the
following apply:
(1) The solicitation document has been approved by the United
States department of health and human services, the United States
office of personnel management, the department of job and family
services, or the department of administrative services.
(2) The solicitation document is filed with the
superintendent of insurance prior to use and is accompanied by
documentation of approval from the United States department of
health and human services, the United States office of personnel
management, the department of job and family services, or the
department of administrative services.
(E) No health insuring corporation, or its agents or
representatives, shall use monetary or other valuable
consideration, engage in misleading or deceptive practices, or
make untrue, misleading, or deceptive representations to induce
enrollment. Nothing in this division shall prohibit incentive
forms of remuneration such as commission sales programs for the
health insuring corporation's employees and agents.
(F) Any person obligated for any part of a premium rate in
connection with an enrollment agreement, in addition to any right
otherwise available to revoke an offer, may cancel such agreement
within seventy-two hours after having signed the agreement or
offer to enroll. Cancellation occurs when written notice of the
cancellation is given to the health insuring corporation or its
agents or other representatives. A notice of cancellation mailed
to the health insuring corporation shall be considered to have
been filed on its postmark date.
(G) Nothing in this section shall prohibit healthy lifestyle
programs.
Section 2. That existing section 1751.31 of the Revised Code
is hereby repealed.
Section 3. (A) During the period beginning on January 1,
2014, and expiring January 1, 2018, the operation of sections
1751.15, 1751.16, 1751.17, 3923.122, 3923.58, 3923.581, 3923.582,
3923.59, 3924.07, 3924.08, 3924.09, 3924.10, 3924.11, 3924.111,
3924.12, 3924.13, and 3924.14 of the Revised Code are suspended.
The suspension shall take effect in accordance with the following:
(1) Carriers shall not be required to offer open enrollment
coverage under the Ohio Open Enrollment Program on or after
January 1, 2014. In addition, carriers shall not reinsure any
insurance policies with the Ohio Health Reinsurance Program during
the suspension of the Program on or after January 1, 2014.
(2) Notwithstanding this section, the Board of Directors of
the Ohio Health Reinsurance Program shall continue to have all of
the authority and protection provided by sections 3924.07 to
3924.14 of the Revised Code during the period beginning January 1,
2014, and ending December 31, 2014, in order to wind up the
affairs of the Ohio Health Reinsurance Program. This shall
include, but is not limited to, the receipt, processing, and
payment of all claims incurred on or before January 1, 2014,
assessments needed to fund the wind up of the Program, the refund
of any excess assessments, and the preparation of final audited
financial statements and tax returns.
(3) With respect to an open enrollment or conversion policy
or contract issued prior to January 1, 2014, a carrier may
terminate such policy or contract on or after January 1, 2014, if
the carrier does both of the following:
(a) Provides notice of termination to the policy or contract
holder at the time the policy is issued or at least ninety days
prior to the termination;
(b) Offers the policy or contract holder the option to
purchase other coverage offered by the insurer to be effective at
the time of the termination.
(4) Carriers shall not be required to include any option to
convert coverage as required by sections 1751.16, 1751.17, and
3923.122 of the Revised Code in any policy or contract issued on
or after January 1, 2014.
(B) If the amendments made by 42 U.S.C. 300gg-1 and 300gg-6,
regarding the requirements related to health insurance coverage,
do not take effect January 1, 2014, or become ineffective prior to
the expiration of the suspension on January 1, 2018, then sections
1751.15, 1751.16, 1751.17, 3923.122, 3923.58, 3923.581, 3923.582,
3923.59, 3924.07, 3924.08, 3924.09, 3924.10, 3924.11, 3924.111,
3924.12, 3924.13, and 3924.14 of the Revised Code, in either their
present form or as they are later amended, again become
operational.
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