(A) The board of directors of the Ohio health reinsurance program shall consist of nine appointed members who shall serve staggered terms as determined by the initial board for its members and by the plan of operation of the program for members of subsequent boards. Within thirty days after April 14, 1993, the members of the board shall be appointed, as follows:
(1) The chairperson of the senate committee having jurisdiction over insurance shall appoint the following members:
(a) Two member carriers that are small employer carriers;
(b) One member carrier that is a health insuring corporation predominantly in the small employer market;
(c) One representative of providers of health care.
(2) The chairperson of the committee in the house of representatives having jurisdiction over insurance shall appoint the following members:
(a) One member carrier that is a small employer carrier;
(b) One member carrier whose principal health insurance business is in the large employer market;
(c) One representative of an employer with fifty or fewer employees;
(d) One representative of consumers in this state.
(3) The superintendent of insurance shall appoint a representative of a member carrier operating in the small employer market who is a fellow of the society of actuaries.
The superintendent, a member of the house of representatives appointed by the speaker of the house of representatives, and a member of the senate appointed by the president of the senate, shall be ex-officio members of the board. The membership of all boards subsequent to the initial board shall reflect the distribution described in division (A) of this section.
The chairperson of the initial board and each subsequent board shall represent a small employer member carrier and shall be elected by a majority of the voting members of the board. Each chairperson shall serve for the maximum duration established in the plan of operation.
(B) Within one hundred eighty days after the appointment of the initial board, the board shall establish a plan of operation and, thereafter, any amendments to the plan that are necessary or suitable, to assure the fair, reasonable, and equitable administration of the program. The board shall, immediately upon adoption, provide to the superintendent copies of the plan of operation and all subsequent amendments to it.
(C) The plan of operation shall establish rules, conditions, and procedures for all of the following:
(1) The handling and accounting of assets and moneys of the program and for an annual fiscal reporting to the superintendent;
(2) Filling vacancies on the board;
(3) Selecting an administrator of the program, and setting forth the powers and duties of the administrator. The administrator may be a carrier as defined in section 3924.01 of the Revised Code or a person licensed as an administrator under Chapter 3959. of the Revised Code, or the board may, in its sole discretion, choose to serve as administrator of the program.
(5) Collecting assessments subject to section 3924.13 of the Revised Code from all members to provide for claims reinsured by the program and for administrative expenses incurred or estimated to be incurred during the period for which the assessment is made;
(6) Providing protection for carriers from the financial risk associated with small employers that present poor credit risks;
(7) Establishing standards for the coverage of small employers that have a high turnover of employees;
(8) Establishing an appeals process for carriers to seek relief when a carrier has experienced an unfair share of administrative and credit risks;
(9) Establishing the adjusted average market premium prices for use by the OHC plans for individuals, for groups of two to twenty-five employees, and for groups of twenty-six to fifty employees that are offered in the state;
(10) Establishing participation standards at issue and renewal for reinsured cases;
(12) Any additional matters as determined by the board.
Suspended by 130th General Assembly File No. 15, SB 9, §3, which provides that during the period beginning on January 1, 2014, and expiring January 1, 2018, the operation of this section is suspended. 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 this section, in either its present form or as later amended, again becomes operational..
Effective Date: 03-22-1999
Related Legislative Provision: See 130th General Assembly File No. 15, SB 9, §3.
See 129th General AssemblyFile No.39, SB 171, §4