(A) The board of directors of the Ohio health reinsurance program may make recommendations to the superintendent of insurance, and the superintendent may adopt or amend by rule adopted in accordance with Chapter 119. of the Revised Code, the OHC basic, standard, and carrier reimbursement plans which, when offered by a carrier, are eligible for reinsurance under the program. The superintendent shall establish the form and level of coverage to be made available by carriers in their OHC plans. The plans shall include benefit levels, deductibles, coinsurance factors, exclusions, and limitations for the plans. The forms and levels of coverage shall specify which components of health benefit plans offered by a carrier may be reinsured. The OHC plans are subject to division (C) of section 3924.02 of the Revised Code and to the provisions in Chapters 1751., 1753., 3923., and any other chapter of the Revised Code that require coverage or the offer of coverage of a health care service or benefit.
(B) Prior to adopting any rule that makes changes to the OHC basic or standard plan, the superintendent shall conduct an actuarial analysis of the cost impact of the proposed rule. The plans may include cost containment features including any of the following:
(1) Utilization review of health care services, including review of the medical necessity of hospital and physician services;
(2) Case management benefit alternatives;
(3) Selective contracting with hospitals, physicians, and other health care providers;
(4) Reasonable benefit differentials applicable to participating and nonparticipating providers;
(5) Employee assistance program options that provide preventive and early intervention mental health and substance abuse services;
(6) Other provisions for the cost-effective management of the plans.
(C) OHC plans established for use by health insuring corporations shall be consistent with the basic method of operation of such corporations.
(D) Each carrier shall certify to the superintendent of insurance, in the form and manner prescribed by the superintendent, that the OHC plans filed by the carrier are in substantial compliance with the provisions of the OHC plans designed or adopted under this section. Upon receipt by the superintendent of the certification, the carrier may use the certified plans.
(E) Each carrier shall, on and after sixty days after the date that the program becomes operational and as a condition of transacting business in this state, renew coverage provided to any individual or group under its OHC plans.
(F) The OHC plans in effect as of June 1, 2009, shall remain in effect until those plans are amended or new plans are adopted in accordance with this section.
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..
Amended by 129th General AssemblyFile No.28,HB 153, §101.01, eff. 9/29/2011.
Amended by 128th General AssemblyFile No.18,HB 300, §1, eff. 5/26/2010.
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
See 128th General AssemblyFile No.18,HB 300, §3