As Passed by the House

130th General Assembly Regular Session 2013-2014

Am. Sub. S. B. No. 288

Senator Eklund 

Cosponsors: Senators Beagle, Brown, Gentile, Kearney, Bacon, Balderson, Burke, Cafaro, Coley, Faber, Gardner, Hite, Hughes, Jones, Jordan, LaRose, Lehner, Manning, Obhof, Oelslager, Patton, Peterson, Sawyer, Schaffer, Seitz, Skindell, Tavares, Turner, Uecker, Widener 

Representatives Adams, R., Amstutz, Anielski, Antonio, Baker, Barnes, Bishoff, Boyce, Buchy, Burkley, Butler, Celebrezze, Cera, Conditt, Derickson, Dovilla, Driehaus, Fedor, Green, Grossman, Johnson, Letson, Mallory, Milkovich, Patterson, Perales, Pillich, Rogers, Ruhl, Schuring, Sears, Sprague, Stinziano, Strahorn, Wachtmann, Young Speaker Batchelder 

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A BILL

To amend sections 1739.061, 1751.14, 1751.69,

1

2329.66, 3769.21, 3923.022, 3923.24, 3923.241,

2

3923.281, 3923.57, 3923.58, 3923.601, 3923.65,

3

3923.83, 3923.85, 3924.01, 4729.291, and 4729.541

4

and to enact sections 143.01 to 143.11, 505.377,

5

737.082, 737.222, and 4731.056 of the Revised Code

6

to create the Volunteer Peace Officers' Dependents

7

Fund to provide death benefits to survivors of

8

volunteer peace officers killed in the line of

9

duty and disability benefits to disabled volunteer

10

peace officers, to clarify the status of volunteer

11

firefighters for purposes of the Patient

12

Protection and Affordable Care Act, to make

13

changes regarding coverage for a dependent child

14

under a parent's health insurance plan and the

15

hours of work needed to qualify for coverage under

16

a small employer health benefit plan, to increase

17

the duration of the health insurance considered to

18

be short-term under certain insurance laws, and to

19

make changes to the chemotherapy parity law, to

20

establish requirements regarding controlled

21

substances containing buprenorphine used for the

22

purpose of treating drug dependence or addiction,

23

and to specify the use of video lottery terminal

24

revenue.

25

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 1739.061, 1751.14, 1751.69, 2329.66,	26
3769.21, 3923.022, 3923.24, 3923.241, 3923.281, 3923.57, 3923.58,	27
3923.601, 3923.65, 3923.83, 3923.85, 3924.01, 4729.291, and	28
4729.541 be amended and sections 143.01, 143.02, 143.03, 143.04,	29
143.05, 143.06, 143.07, 143.08, 143.09, 143.10, 143.11, 505.377,	30
737.082, 737.222, and 4731.056 of the Revised Code be enacted to	31
read as follows:	32

Sec. 143.01.  As used in this chapter:

33

(A) "Killed in the line of duty" means either of the	34
following:	35

(1) Death in the line of duty;

36

(2) Death from injury sustained in the line of duty,	37
including heart attack or other fatal injury or illness caused	38
while in the line of duty.	39

(B) "Totally and permanently disabled" means unable to engage	40
in any substantial gainful employment for a period of not less	41
than twelve months by reason of a medically determinable physical	42
impairment that is permanent or presumed to be permanent.	43

(C) "Volunteer peace officer" means any person who is	44
employed as a police officer, sheriff's deputy, constable, or	45
deputy marshal in a part-time, reserve, or volunteer capacity by a	46
county sheriff's department or the police department of a	47
municipal corporation, township, township police district, or	48
joint police district and is not a member of the public employees	49
retirement system, Ohio police and fire pension fund, state	50
highway patrol retirement system, or the Cincinnati retirement	51
system.	52

Sec. 143.02.  (A) There is hereby established the volunteer	53
peace officers dependents fund.	54

Each county, municipal corporation, township, township police	55
district, and joint police district with a police or sheriff's	56
department that employs volunteer peace officers is a member of	57
the volunteer peace officers' dependents fund and shall establish	58
a volunteer peace officers' dependents fund board. Each board	59
shall consist of the following board members:	60

(1) Two board members, elected by the legislative authority	61
of the fund member that maintains the police or sheriff's	62
department;	63

(2) Two board members, elected by the volunteer peace	64
officers of the police or sheriff's department;	65

(3) One board member, elected by the board members elected	66
pursuant to divisions (A)(1) and (2) of this section. The board	67
member must be an elector of the fund member in which the police	68
or sheriff's department is located, but not a public employee,	69
member of the legislative authority, or peace officer of that	70
peace or sheriff's department.	71

(B) The term of office of a board member begins the first day	72
of January and is one year.	73

(C)(1) The election of the board members specified in	74
division (A)(1) of this section shall be held each year not	75
earlier than the first day of November and not later than the	76
second Monday in December. The election of the member specified in	77
division (A)(3) of this section shall be held each year on or	78
before the thirty-first day of December.	79

(2) The members specified in division (A)(2) of this section	80
shall be elected on or before the second Monday in December, as	81
follows:	82

(a) The secretary of the board shall give notice of the	83
election by posting it in a conspicuous place at the headquarters	84
of the police or sheriff's department. Between nine a.m. and nine	85
p.m. on the day designated, each person eligible to vote shall	86
send in writing the name of two persons eligible to be elected to	87
the board who are the person's choices.	88

(b) All votes cast at the election shall be counted and	89
recorded by the board, which shall announce the result. The two	90
persons receiving the highest number of votes are elected. If	91
there is a tie vote for any two persons, the election shall be	92
decided by lot or in any other way agreed on by the persons for	93
whom the tie vote was cast.	94

(D) Any vacancy occurring on a board shall be filled at a	95
special election called by the board's secretary.	96

Sec. 143.03.  A volunteer peace officers' dependents fund	97
board shall meet promptly after election of the board's members	98
and organize. The board shall select from among its members a	99
chairperson and a secretary.	100

The secretary of the board shall keep a complete record of	101
the board's proceedings, which shall be maintained as a permanent	102
file.	103

Board members shall serve without compensation.

104

The legislative authority of the fund member shall provide	105
sufficient meeting space and supplies for the board to carry out	106
its duties.	107

The secretary shall submit all of the following to the	108
director of commerce:	109

(A) The name and address of each board member and an	110
indication of the group or authority that elected the member;	111

(B) The names of the chairperson and secretary;

112

(C) A certificate indicating the current assessed property	113
valuation of the fund member that is prepared by the clerk of the	114
fund member.	115

Sec. 143.04.  Each volunteer peace officers' dependents fund	116
board may adopt rules as necessary for handling and processing	117
claims for benefits.	118

The board shall perform such other duties as are necessary to	119
implement this chapter.	120

Sec. 143.05.  The prosecuting attorney of the county in which	121
a fund member is located shall serve as the legal advisor for the	122
volunteer peace officer's dependents' board.	123

Sec. 143.06.  (A) The volunteer peace officers' dependents	124
fund shall be maintained in the state treasury. All investment	125
earnings of the fund shall be collected by the treasurer of state	126
and placed to the credit of the fund.	127

(B) Each fund member shall pay to the treasurer of state, to	128
the credit of the fund, an initial premium as follows:	129

(1) Each member with an assessed property valuation of less	130
than seven million dollars, three hundred dollars;	131

(2) Each member with an assessed property valuation of seven	132
million dollars but less than fourteen million dollars, three	133
hundred fifty dollars;	134

(3) Each member with an assessed property valuation of	135
fourteen million dollars but less than twenty-one million dollars,	136
four hundred dollars;	137

(4) Each member with an assessed property valuation of	138
twenty-one million dollars but less than twenty-eight million	139
dollars, four hundred fifty dollars;	140

(5) Each member with an assessed property valuation of	141
twenty-eight million dollars or over, five hundred dollars.	142

Sec. 143.07.  The total of all initial premiums collected by	143
the treasurer of state under section 143.06 of the Revised Code is	144
the basic capital account of the volunteer peace officers'	145
dependents fund. No further contributions are required of fund	146
members until claims against the fund have reduced it to	147
ninety-five per cent or less of its basic capital account. In that	148
event, the director of commerce shall cause the following	149
assessments, based on current property valuation, to be made and	150
certified to the legislative authority of each member of the fund:	151

(A) Each member with an assessed property valuation of less	152
than seven million dollars, ninety dollars;	153

(B) Each member with an assessed property valuation of seven	154
million dollars but less than fourteen million dollars, one	155
hundred five dollars;	156

(C) Each member with an assessed property valuation of	157
fourteen million dollars but less than twenty-one million dollars,	158
one hundred twenty dollars;	159

(D) Each member with an assessed property valuation of	160
twenty-one million dollars but less than twenty-eight million	161
dollars, one hundred thirty-five dollars;	162

(E) Each member with an assessed property valuation of	163
twenty-eight million dollars or more, one hundred fifty dollars.	164

Sec. 143.08.  (A) If a premium is not paid as provided in	165
section 143.06 of the Revised Code, the director of commerce shall	166
certify the failure as an assessment against the fund member to	167
the auditor of the county within which the member is located. The	168
county auditor shall withhold the amount of the assessment,	169
together with interest at the rate of six per cent from the due	170
date of the premium, from the next ensuing tax settlement due the	171
member and pay the amount to the treasurer of state to the credit	172
of the volunteer peace officers' dependents fund.	173

If the secretary of a volunteer peace officers' dependents	174
fund board fails to submit to the director a certificate of the	175
current assessed property valuation in accordance with section	176
143.03 of the Revised Code, the director shall use division (B)(5)	177
of section 143.06 of the Revised Code as a basis for the	178
assessment.	179

(B) If a fund member does not pay the assessment provided in	180
section 143.07 of the Revised Code within forty-five days after	181
notice, the director shall proceed with collection in accordance	182
with division (A) of this section.	183

Sec. 143.09.  (A) A volunteer peace officer who is totally	184
and permanently disabled as a result of discharging the duties of	185
a volunteer peace officer shall receive a benefit from the	186
volunteer peace officers' dependents fund of three hundred dollars	187
per month, except that no payment shall be made to a volunteer	188
peace officer who is receiving the officer's full salary during	189
the time of the officer's disability.	190

(B) Regardless of whether the volunteer peace officer	191
received a benefit under division (A) of this section, death	192
benefits shall be paid from the fund to the surviving spouse or	193
dependent children of a volunteer peace officer who is killed in	194
the line of duty. Death benefits shall be paid as follows:	195

(1) To the surviving spouse of a volunteer peace officer	196
killed in the line of duty, an award of one thousand dollars, and	197
in addition, a benefit of three hundred dollars per month;	198

(2) To the parent, guardian, or other persons on whom a child	199
of a volunteer peace officer killed in the line of duty is	200
dependent for chief financial support, a benefit of one hundred	201
twenty-five dollars per month for each dependent child under age	202
eighteen, or under age twenty-two if attending an institution of	203
learning or training pursuant to a program designed to complete in	204
each school year the equivalent of at least two-thirds of the	205
full-time curriculum requirements of the institution.	206

(C) An individual eligible for benefits payable under this	207
section shall file a claim for benefits with the appropriate	208
volunteer peace officers' dependents fund board on a form provided	209
by the board. All of the following information shall be submitted	210
with the claim:	211

(1) In the case of a totally and permanently disabled	212
volunteer peace officer, the following:	213

(a) The name of the police or sheriff's department for which	214
the officer was a volunteer peace officer;	215

(b) The date of the injury;

216

(c) Satisfactory medical evidence that the officer is totally	217
and permanently disabled.	218

(2) In the case of a surviving spouse or a parent, guardian,	219
or other person in charge of a dependent child, the following:	220

(a) The full name of the deceased volunteer peace officer;

221

(b) The name of the police or sheriff's department for which	222
the deceased officer was a volunteer peace officer;	223

(c) The name and address of the surviving spouse, as	224
applicable;	225

(d) The names, ages, and addresses of any dependent children;

226

(e) Any other evidence required by the board.

227

(D) All claimants shall certify that neither the claimant nor	228
the person on whose behalf the claim is filed qualifies for other	229
benefits from any of the following based on the officer's service	230
as a volunteer peace officer: the public employees retirement	231
system, Ohio police and fire pension fund, state highway patrol	232
retirement system, Cincinnati retirement system, or Ohio public	233
safety officers death benefit fund.	234

(E) Initial claims shall be filed with the volunteer peace	235
officers' dependents fund board of the fund member in which the	236
officer was a volunteer peace officer. Thereafter, on request of	237
the claimant or the board, claims may be transferred to a board	238
near the claimant's current residence, if the boards concerned	239
agree to the transfer.	240

Sec. 143.10.  (A)(1) Not later than five days after receipt	241
of a claim for benefits, a volunteer peace officers' dependents	242
fund board shall meet and determine the validity of the claim. If	243
the board determines that the claim is valid, it shall make a	244
determination of the amount due and certify its determination to	245
the director of commerce for payment. The certificate shall show	246
the name and address of the board, the name and address of each	247
beneficiary, the amount to be received by or on behalf of each	248
beneficiary, and the name and address of the person to whom	249
payments are to be made.	250

(2) If the board determines that a claimant is ineligible for	251
benefits, the board shall deny the claim and issue to the claimant	252
a copy of its order.	253

(B) The board may make a continuing order for monthly	254
payments to a claimant for a period not exceeding three months	255
from the date of the determination. The determination may be	256
modified after issuance to reflect any changes in the claimant's	257
eligibility. If no changes occur at the end of the three-month	258
period, the director may provide for payment if the board	259
certifies that the original certificate is continued for an	260
additional three-month period.	261

Sec. 143.11.  The right of an individual to a benefit under	262
this chapter shall not be subject to execution, garnishment,	263
attachment, the operation of bankruptcy or insolvency laws, or	264
other process of law whatsoever, and shall be unassignable except	265
as specifically provided in this chapter and sections 3105.171,	266
3105.65, and 3115.32 and Chapters 3119., 3121., 3123., and 3125.	267
of the Revised Code.	268

Sec. 505.377.  A volunteer firefighter appointed pursuant to	269
this chapter is a bona fide volunteer and not an employee for	270
purposes of section 513 of the "Patient Protection and Affordable	271
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	272
providing those fire protection services, the volunteer receives	273
any of the benefits provided in Chapter 146., 4121., or 4123. or	274
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	275
Code.	276

Sec. 737.082.  A volunteer firefighter appointed pursuant to	277
this chapter is a bona fide volunteer and not an employee for	278
purposes of section 513 of the "Patient Protection and Affordable	279
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	280
providing those fire protection services, the volunteer receives	281
any of the benefits provided in Chapter 146., 4121., or 4123. or	282
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	283
Code.	284

Sec. 737.222.  A volunteer firefighter appointed pursuant to	285
this chapter is a bona fide volunteer and not an employee for	286
purposes of section 513 of the "Patient Protection and Affordable	287
Care Act," 124 Stat. 119 (2010), 26 U.S.C. 4980H, if, for	288
providing those fire protection services, the volunteer receives	289
any of the benefits provided in Chapter 146., 4121., or 4123. or	290
section 9.65, 505.23, 3333.26, 3923.13, or 4113.41 of the Revised	291
Code.	292

Sec. 1739.061. (A)(1) This section applies to both of the	293
following:	294

(a) A multiple employer welfare arrangement that issues or	295
requires the use of a standardized identification card or an	296
electronic technology for submission and routing of prescription	297
drug claims;	298

(b) A person or entity that a multiple employer welfare	299
arrangement contracts with to issue a standardized identification	300
card or an electronic technology described in division (A)(1)(a)	301
of this section.	302

(2) Notwithstanding division (A)(1) of this section, this	303
section does not apply to the issuance or required use of a	304
standardized identification card or an electronic technology for	305
the submission and routing of prescription drug claims in	306
connection with any of the following:	307

(a) Any program or arrangement covering only accident,	308
credit, dental, disability income, long-term care, hospital	309
indemnity, medicare supplement, medicare, tricare, specified	310
disease, or vision care; coverage under a	311
one-time-limited-duration policy of not longerthat is less than	312
sixtwelve months; coverage issued as a supplement to liability	313
insurance; insurance arising out of workers' compensation or	314
similar law; automobile medical payment insurance; or insurance	315
under which benefits are payable with or without regard to fault	316
and which is statutorily required to be contained in any liability	317
insurance policy or equivalent self-insurance.	318

(b) Coverage provided under the medicaid program.

319

(c) Coverage provided under an employer's self-insurance plan	320
or by any of its administrators, as defined in section 3959.01 of	321
the Revised Code, to the extent that federal law supersedes,	322
preempts, prohibits, or otherwise precludes the application of	323
this section to the plan and its administrators.	324

(B) A standardized identification card or an electronic	325
technology issued or required to be used as provided in division	326
(A)(1) of this section shall contain uniform prescription drug	327
information in accordance with either division (B)(1) or (2) of	328
this section.	329

(1) The standardized identification card or the electronic	330
technology shall be in a format and contain information fields	331
approved by the national council for prescription drug programs or	332
a successor organization, as specified in the council's or	333
successor organization's pharmacy identification card	334
implementation guide in effect on the first day of October most	335
immediately preceding the issuance or required use of the	336
standardized identification card or the electronic technology.	337

(2) If the multiple employer welfare arrangement or person	338
under contract with it to issue a standardized identification card	339
or an electronic technology requires the information for the	340
submission and routing of a claim, the standardized identification	341
card or the electronic technology shall contain any of the	342
following information:	343

(a) The name of the multiple employer welfare arrangement;

344

(b) The individual's name, group number, and identification	345
number;	346

(c) A telephone number to inquire about pharmacy-related	347
issues;	348

(d) The issuer's international identification number, labeled	349
as "ANSI BIN" or "RxBIN";	350

(e) The processor's control number, labeled as "RxPCN";

351

(f) The individual's pharmacy benefits group number if	352
different from the insured's medical group number, labeled as	353
"RxGrp."	354

(C) If the standardized identification card or the electronic	355
technology issued or required to be used as provided in division	356
(A)(1) of this section is also used for submission and routing of	357
nonpharmacy claims, the designation "Rx" is required to be	358
included as part of the labels identified in divisions (B)(2)(d)	359
and (e) of this section if the issuer's international	360
identification number or the processor's control number is	361
different for medical and pharmacy claims.	362

(D) Each multiple employer welfare arrangement described in	363
division (A) of this section shall annually file a certificate	364
with the superintendent of insurance certifying that it or any	365
person it contracts with to issue a standardized identification	366
card or electronic technology for submission and routing of	367
prescription drug claims complies with this section.	368

(E)(1) Except as provided in division (E)(2) of this section,	369
if there is a change in the information contained in the	370
standardized identification card or the electronic technology	371
issued to an individual, the multiple employer welfare arrangement	372
or person under contract with it to issue a standardized	373
identification card or an electronic technology shall issue a new	374
card or electronic technology to the individual.	375

(2) A multiple employer welfare arrangement or person under	376
contract with it is not required under division (E)(1) of this	377
section to issue a new card or electronic technology to an	378
individual more than once during a twelve-month period.	379

(F) Nothing in this section shall be construed as requiring a	380
multiple employer welfare arrangement to produce more than one	381
standardized identification card or one electronic technology for	382
use by individuals accessing health care benefits provided under a	383
multiple employer welfare arrangement.	384

Sec. 1751.14.  (A) Notwithstanding section 3901.71 of the	385
Revised Code, any policy, contract, or agreement for health care	386
services authorized by this chapter that is issued, delivered, or	387
renewed in this state and that provides that coverage of an	388
unmarried dependent child will terminate upon attainment of the	389
limiting age for dependent children specified in the policy,	390
contract, or agreement, shall also provide in substance both of	391
the following:	392

(1) Once an unmarried child has attained the limiting age for	393
dependent children, as provided in the policy, contract, or	394
agreement, upon the request of the subscriber, the health insuring	395
corporation shall offer to cover the unmarried child until the	396
child attains twenty-eighttwenty-six years of age if all of the	397
following are true:	398

(a) The child is the natural child, stepchild, or adopted	399
child of the subscriber.	400

(b) The child is a resident of this state or a full-time	401
student at an accredited public or private institution of higher	402
education.	403

(c) The child is not employed by an employer that offers any	404
health benefit plan under which the child is eligible for	405
coverage.	406

(d) The child is not eligible for coverage under the medicaid	407
program or the medicare program.	408

(2) That attainment of the limiting age for dependent	409
children shall not operate to terminate the coverage of a	410
dependent child if the child is and continues to be both of the	411
following:	412

(a) Incapable of self-sustaining employment by reason of	413
mental retardation or physical handicap;	414

(b) Primarily dependent upon the subscriber for support and	415
maintenance.	416

(B) Proof of incapacity and dependence for purposes of	417
division (A)(2) of this section shall be furnished to the health	418
insuring corporation within thirty-one days of the child's	419
attainment of the limiting age. Upon request, but not more	420
frequently than annually, the health insuring corporation may	421
require proof satisfactory to it of the continuance of such	422
incapacity and dependency.	423

(C) Nothing in this section shall do any of the following:

424

(1) Require that any policy, contract, or agreement offer	425
coverage for dependent children or provide coverage for an	426
unmarried dependent child's children as dependents on the policy,	427
contract, or agreement;	428

(2) Require an employer to pay for any part of the premium	429
for an unmarried dependent child that has attained the limiting	430
age for dependents, as provided in the policy, contract, or	431
agreement;	432

(3) Require an employer to offer health insurance coverage to	433
the dependents of any employee.	434

(D) This section does not apply to any health insuring	435
corporation policy, contract, or agreement offering only	436
supplemental health care services or specialty health care	437
services.	438

(E) As used in this section, "health benefit plan" has the	439
same meaning as in section 3924.01 of the Revised Code and also	440
includes both of the following:	441

(1) A public employee benefit plan;

442

(2) A health benefit plan as regulated under the "Employee	443
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	444

Sec. 1751.69.  (A) As used in this section, "cost sharing"	445
means the cost to an individual insured under an individual or	446
group health insuring corporation policy, contract, or agreement	447
according to any coverage limit, copayment, coinsurance,	448
deductible, or other out-of-pocket expense requirements imposed by	449
the policy, contract, or agreement.	450

(B) Notwithstanding section 3901.71 of the Revised Code and	451
subject to division (D) of this section, no individual or group	452
health insuring corporation policy, contract, or agreement	453
providing basic health care services or prescription drug services	454
that is delivered, issued for delivery, or renewed in this state,	455
if the policy, contract, or agreement provides coverage for cancer	456
chemotherapy treatment, shall fail to comply with either of the	457
following:	458

(1) The policy, contract, or agreement shall not provide	459
coverage or impose cost sharing for a prescribed, orally	460
administered cancer medication on a less favorable basis than the	461
coverage it provides or cost sharing it imposes for intraveneously	462
administered or injected cancer medications.	463

(2) The policy, contract, or agreement shall not comply with	464
division (B)(1) of this section by imposing an increase in cost	465
sharing solely for orally administered, intravenously	466
administered, or injected cancer medications.	467

(C) Notwithstanding any provision of this section to the	468
contrary, an individual or group health insuring corporation	469
policy, contract, or agreement shall be deemed to be in compliance	470
with this section if the cost sharing imposed under such a policy,	471
contract, or agreement for orally administered cancer treatments	472
does not exceed one hundred dollars per prescription fill. The	473
cost sharing limit of one hundred dollars per prescription fill	474
shall apply to a high deductible plan, as defined in 26 U.S.C.	475
223, or a catastrophic plan, as defined in 42 U.S.C. 18022, only	476
after the deductible has been met.	477

(D) The prohibitions in division (B) of this section do not	478
preclude an individual or group health insuring corporation	479
policy, contract, or agreement from requiring an enrollee to	480
obtain prior authorization before orally administered cancer	481
medication is dispensed to the enrollee.	482

(E) A health insuring corporation that offers coverage for	483
basic health care services is not required to comply with division	484
(B) of this section if all of the following apply:	485

(1) The health insuring corporation submits documentation	486
certified by an independent member of the American academy of	487
actuaries to the superintendent of insurance showing that	488
compliance with division (B)(1) of this section for a period of at	489
least six months independently caused the health insuring	490
corporation's costs for claims and administrative expenses for the	491
coverage of basic health care services to increase by more than	492
one per cent per year.	493

(2) The health insuring corporation submits a signed letter	494
from an independent member of the American academy of actuaries to	495
the superintendent of insurance opining that the increase in costs	496
described in division (E)(1) of this section could reasonably	497
justify an increase of more than one per cent in the annual	498
premiums or rates charged by the health insuring corporation for	499
the coverage of basic health care services.	500

(3)(a) The superintendent of insurance makes the following	501
determinations from the documentation and opinion submitted	502
pursuant to divisions (E)(1) and (2) of this section:	503

(i) Compliance with division (B)(1) of this section for a	504
period of at least six months independently caused the health	505
insuring corporation's costs for claims and administrative	506
expenses for the coverage of basic health care services to	507
increase more than one per cent per year.	508

(ii) The increase in costs reasonably justifies an increase	509
of more than one per cent in the annual premiums or rates charged	510
by the health insuring corporation for the coverage of basic	511
health care services.	512

(b) Any determination made by the superintendent under	513
division (E)(3) of this section is subject to Chapter 119. of the	514
Revised Code.	515

Sec. 2329.66.  (A) Every person who is domiciled in this	516
state may hold property exempt from execution, garnishment,	517
attachment, or sale to satisfy a judgment or order, as follows:	518

(1)(a) In the case of a judgment or order regarding money	519
owed for health care services rendered or health care supplies	520
provided to the person or a dependent of the person, one parcel or	521
item of real or personal property that the person or a dependent	522
of the person uses as a residence. Division (A)(1)(a) of this	523
section does not preclude, affect, or invalidate the creation	524
under this chapter of a judgment lien upon the exempted property	525
but only delays the enforcement of the lien until the property is	526
sold or otherwise transferred by the owner or in accordance with	527
other applicable laws to a person or entity other than the	528
surviving spouse or surviving minor children of the judgment	529
debtor. Every person who is domiciled in this state may hold	530
exempt from a judgment lien created pursuant to division (A)(1)(a)	531
of this section the person's interest, not to exceed one hundred	532
twenty-five thousand dollars, in the exempted property.	533

(b) In the case of all other judgments and orders, the	534
person's interest, not to exceed one hundred twenty-five thousand	535
dollars, in one parcel or item of real or personal property that	536
the person or a dependent of the person uses as a residence.	537

(c) For purposes of divisions (A)(1)(a) and (b) of this	538
section, "parcel" means a tract of real property as identified on	539
the records of the auditor of the county in which the real	540
property is located.	541

(2) The person's interest, not to exceed three thousand two	542
hundred twenty-five dollars, in one motor vehicle;	543

(3) The person's interest, not to exceed four hundred	544
dollars, in cash on hand, money due and payable, money to become	545
due within ninety days, tax refunds, and money on deposit with a	546
bank, savings and loan association, credit union, public utility,	547
landlord, or other person, other than personal earnings.	548

(4)(a) The person's interest, not to exceed five hundred	549
twenty-five dollars in any particular item or ten thousand seven	550
hundred seventy-five dollars in aggregate value, in household	551
furnishings, household goods, wearing apparel, appliances, books,	552
animals, crops, musical instruments, firearms, and hunting and	553
fishing equipment that are held primarily for the personal,	554
family, or household use of the person;	555

(b) The person's aggregate interest in one or more items of	556
jewelry, not to exceed one thousand three hundred fifty dollars,	557
held primarily for the personal, family, or household use of the	558
person or any of the person's dependents.	559

(5) The person's interest, not to exceed an aggregate of two	560
thousand twenty-five dollars, in all implements, professional	561
books, or tools of the person's profession, trade, or business,	562
including agriculture;	563

(6)(a) The person's interest in a beneficiary fund set apart,	564
appropriated, or paid by a benevolent association or society, as	565
exempted by section 2329.63 of the Revised Code;	566

(b) The person's interest in contracts of life or endowment	567
insurance or annuities, as exempted by section 3911.10 of the	568
Revised Code;	569

(c) The person's interest in a policy of group insurance or	570
the proceeds of a policy of group insurance, as exempted by	571
section 3917.05 of the Revised Code;	572

(d) The person's interest in money, benefits, charity,	573
relief, or aid to be paid, provided, or rendered by a fraternal	574
benefit society, as exempted by section 3921.18 of the Revised	575
Code;	576

(e) The person's interest in the portion of benefits under	577
policies of sickness and accident insurance and in lump sum	578
payments for dismemberment and other losses insured under those	579
policies, as exempted by section 3923.19 of the Revised Code.	580

(7) The person's professionally prescribed or medically	581
necessary health aids;	582

(8) The person's interest in a burial lot, including, but not	583
limited to, exemptions under section 517.09 or 1721.07 of the	584
Revised Code;	585

(9) The person's interest in the following:

586

(a) Moneys paid or payable for living maintenance or rights,	587
as exempted by section 3304.19 of the Revised Code;	588

(b) Workers' compensation, as exempted by section 4123.67 of	589
the Revised Code;	590

(c) Unemployment compensation benefits, as exempted by	591
section 4141.32 of the Revised Code;	592

(d) Cash assistance payments under the Ohio works first	593
program, as exempted by section 5107.75 of the Revised Code;	594

(e) Benefits and services under the prevention, retention,	595
and contingency program, as exempted by section 5108.08 of the	596
Revised Code;	597

(f) Disability financial assistance payments, as exempted by	598
section 5115.06 of the Revised Code;	599

(g) Payments under section 24 or 32 of the "Internal Revenue	600
Code of 1986," 100 Stat. 2085, 26 U.S.C. 1, as amended.	601

(10)(a) Except in cases in which the person was convicted of	602
or pleaded guilty to a violation of section 2921.41 of the Revised	603
Code and in which an order for the withholding of restitution from	604
payments was issued under division (C)(2)(b) of that section, in	605
cases in which an order for withholding was issued under section	606
2907.15 of the Revised Code, in cases in which an order for	607
forfeiture was issued under division (A) or (B) of section	608
2929.192 of the Revised Code, and in cases in which an order was	609
issued under section 2929.193 or 2929.194 of the Revised Code, and	610
only to the extent provided in the order, and except as provided	611
in sections 3105.171, 3105.63, 3119.80, 3119.81, 3121.02, 3121.03,	612
and 3123.06 of the Revised Code, the person's rights to or	613
interests in a pension, benefit, annuity, retirement allowance, or	614
accumulated contributions, the person's rights to or interests in	615
a participant account in any deferred compensation program offered	616
by the Ohio public employees deferred compensation board, a	617
government unit, or a municipal corporation, or the person's other	618
accrued or accruing rights or interests, as exempted by section	619
143.11, 145.56, 146.13, 148.09, 742.47, 3307.41, 3309.66, or	620
5505.22 of the Revised Code, and the person's rights to or	621
interests in benefits from the Ohio public safety officers death	622
benefit fund;	623

(b) Except as provided in sections 3119.80, 3119.81, 3121.02,	624
3121.03, and 3123.06 of the Revised Code, the person's rights to	625
receive or interests in receiving a payment or other benefits	626
under any pension, annuity, or similar plan or contract, not	627
including a payment or benefit from a stock bonus or	628
profit-sharing plan or a payment included in division (A)(6)(b) or	629
(10)(a) of this section, on account of illness, disability, death,	630
age, or length of service, to the extent reasonably necessary for	631
the support of the person and any of the person's dependents,	632
except if all the following apply:	633

(i) The plan or contract was established by or under the	634
auspices of an insider that employed the person at the time the	635
person's rights or interests under the plan or contract arose.	636

(ii) The payment is on account of age or length of service.

637

(iii) The plan or contract is not qualified under the	638
"Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C. 1, as	639
amended.	640

(c) Except for any portion of the assets that were deposited	641
for the purpose of evading the payment of any debt and except as	642
provided in sections 3119.80, 3119.81, 3121.02, 3121.03, and	643
3123.06 of the Revised Code, the person's rights or interests in	644
the assets held in, or to directly or indirectly receive any	645
payment or benefit under, any individual retirement account,	646
individual retirement annuity, "Roth IRA," "529 plan," or	647
education individual retirement account that provides payments or	648
benefits by reason of illness, disability, death, retirement, or	649
age or provides payments or benefits for purposes of education, to	650
the extent that the assets, payments, or benefits described in	651
division (A)(10)(c) of this section are attributable to or derived	652
from any of the following or from any earnings, dividends,	653
interest, appreciation, or gains on any of the following:	654

(i) Contributions of the person that were less than or equal	655
to the applicable limits on deductible contributions to an	656
individual retirement account or individual retirement annuity in	657
the year that the contributions were made, whether or not the	658
person was eligible to deduct the contributions on the person's	659
federal tax return for the year in which the contributions were	660
made;	661

(ii) Contributions of the person that were less than or equal	662
to the applicable limits on contributions to a Roth IRA or	663
education individual retirement account in the year that the	664
contributions were made;	665

(iii) Contributions of the person that are within the	666
applicable limits on rollover contributions under subsections 219,	667
402(c), 403(a)(4), 403(b)(8), 408(b), 408(d)(3), 408A(c)(3)(B),	668
408A(d)(3), and 530(d)(5) of the "Internal Revenue Code of 1986,"	669
100 Stat. 2085, 26 U.S.C.A. 1, as amended;	670

(iv) Contributions by any person into any plan, fund, or	671
account that is formed, created, or administered pursuant to, or	672
is otherwise subject to, section 529 of the "Internal Revenue Code	673
of 1986," 100 Stat. 2085, 26 U.S.C. 1, as amended.	674

(d) Except for any portion of the assets that were deposited	675
for the purpose of evading the payment of any debt and except as	676
provided in sections 3119.80, 3119.81, 3121.02, 3121.03, and	677
3123.06 of the Revised Code, the person's rights or interests in	678
the assets held in, or to receive any payment under, any Keogh or	679
"H.R. 10" plan that provides benefits by reason of illness,	680
disability, death, retirement, or age, to the extent reasonably	681
necessary for the support of the person and any of the person's	682
dependents.	683

(e) The person's rights to or interests in any assets held	684
in, or to directly or indirectly receive any payment or benefit	685
under, any individual retirement account, individual retirement	686
annuity, "Roth IRA," "529 plan," or education individual	687
retirement account that a decedent, upon or by reason of the	688
decedent's death, directly or indirectly left to or for the	689
benefit of the person, either outright or in trust or otherwise,	690
including, but not limited to, any of those rights or interests in	691
assets or to receive payments or benefits that were transferred,	692
conveyed, or otherwise transmitted by the decedent by means of a	693
will, trust, exercise of a power of appointment, beneficiary	694
designation, transfer or payment on death designation, or any	695
other method or procedure.	696

(f) The exemptions under divisions (A)(10)(a) to (e) of this	697
section also shall apply or otherwise be available to an alternate	698
payee under a qualified domestic relations order (QDRO) or other	699
similar court order.	700

(g) A person's interest in any plan, program, instrument, or	701
device described in divisions (A)(10)(a) to (e) of this section	702
shall be considered an exempt interest even if the plan, program,	703
instrument, or device in question, due to an error made in good	704
faith, failed to satisfy any criteria applicable to that plan,	705
program, instrument, or device under the "Internal Revenue Code of	706
1986," 100 Stat. 2085, 26 U.S.C. 1, as amended.	707

(11) The person's right to receive spousal support, child	708
support, an allowance, or other maintenance to the extent	709
reasonably necessary for the support of the person and any of the	710
person's dependents;	711

(12) The person's right to receive, or moneys received during	712
the preceding twelve calendar months from, any of the following:	713

(a) An award of reparations under sections 2743.51 to 2743.72	714
of the Revised Code, to the extent exempted by division (D) of	715
section 2743.66 of the Revised Code;	716

(b) A payment on account of the wrongful death of an	717
individual of whom the person was a dependent on the date of the	718
individual's death, to the extent reasonably necessary for the	719
support of the person and any of the person's dependents;	720

(c) Except in cases in which the person who receives the	721
payment is an inmate, as defined in section 2969.21 of the Revised	722
Code, and in which the payment resulted from a civil action or	723
appeal against a government entity or employee, as defined in	724
section 2969.21 of the Revised Code, a payment, not to exceed	725
twenty thousand two hundred dollars, on account of personal bodily	726
injury, not including pain and suffering or compensation for	727
actual pecuniary loss, of the person or an individual for whom the	728
person is a dependent;	729

(d) A payment in compensation for loss of future earnings of	730
the person or an individual of whom the person is or was a	731
dependent, to the extent reasonably necessary for the support of	732
the debtor and any of the debtor's dependents.	733

(13) Except as provided in sections 3119.80, 3119.81,	734
3121.02, 3121.03, and 3123.06 of the Revised Code, personal	735
earnings of the person owed to the person for services in an	736
amount equal to the greater of the following amounts:	737

(a) If paid weekly, thirty times the current federal minimum	738
hourly wage; if paid biweekly, sixty times the current federal	739
minimum hourly wage; if paid semimonthly, sixty-five times the	740
current federal minimum hourly wage; or if paid monthly, one	741
hundred thirty times the current federal minimum hourly wage that	742
is in effect at the time the earnings are payable, as prescribed	743
by the "Fair Labor Standards Act of 1938," 52 Stat. 1060, 29	744
U.S.C. 206(a)(1), as amended;	745

(b) Seventy-five per cent of the disposable earnings owed to	746
the person.	747

(14) The person's right in specific partnership property, as	748
exempted by the person's rights in a partnership pursuant to	749
section 1776.50 of the Revised Code, except as otherwise set forth	750
in section 1776.50 of the Revised Code;	751

(15) A seal and official register of a notary public, as	752
exempted by section 147.04 of the Revised Code;	753

(16) The person's interest in a tuition unit or a payment	754
under section 3334.09 of the Revised Code pursuant to a tuition	755
payment contract, as exempted by section 3334.15 of the Revised	756
Code;	757

(17) Any other property that is specifically exempted from	758
execution, attachment, garnishment, or sale by federal statutes	759
other than the "Bankruptcy Reform Act of 1978," 92 Stat. 2549, 11	760
U.S.C.A. 101, as amended;	761

(18) The person's aggregate interest in any property, not to	762
exceed one thousand seventy-five dollars, except that division	763
(A)(18) of this section applies only in bankruptcy proceedings.	764

(B) On April 1, 2010, and on the first day of April in each	765
third calendar year after 2010, the Ohio judicial conference shall	766
adjust each dollar amount set forth in this section to reflect any	767
increase in the consumer price index for all urban consumers, as	768
published by the United States department of labor, or, if that	769
index is no longer published, a generally available comparable	770
index, for the three-year period ending on the thirty-first day of	771
December of the preceding year. Any adjustments required by this	772
division shall be rounded to the nearest twenty-five dollars.	773

The Ohio judicial conference shall prepare a memorandum	774
specifying the adjusted dollar amounts. The judicial conference	775
shall transmit the memorandum to the director of the legislative	776
service commission, and the director shall publish the memorandum	777
in the register of Ohio. (Publication of the memorandum in the	778
register of Ohio shall continue until the next memorandum	779
specifying an adjustment is so published.) The judicial conference	780
also may publish the memorandum in any other manner it concludes	781
will be reasonably likely to inform persons who are affected by	782
its adjustment of the dollar amounts.	783

(C) As used in this section:

784

(1) "Disposable earnings" means net earnings after the	785
garnishee has made deductions required by law, excluding the	786
deductions ordered pursuant to section 3119.80, 3119.81, 3121.02,	787
3121.03, or 3123.06 of the Revised Code.	788

(2) "Insider" means:

789

(a) If the person who claims an exemption is an individual, a	790
relative of the individual, a relative of a general partner of the	791
individual, a partnership in which the individual is a general	792
partner, a general partner of the individual, or a corporation of	793
which the individual is a director, officer, or in control;	794

(b) If the person who claims an exemption is a corporation, a	795
director or officer of the corporation; a person in control of the	796
corporation; a partnership in which the corporation is a general	797
partner; a general partner of the corporation; or a relative of a	798
general partner, director, officer, or person in control of the	799
corporation;	800

(c) If the person who claims an exemption is a partnership, a	801
general partner in the partnership; a general partner of the	802
partnership; a person in control of the partnership; a partnership	803
in which the partnership is a general partner; or a relative in, a	804
general partner of, or a person in control of the partnership;	805

(d) An entity or person to which or whom any of the following	806
applies:	807

(i) The entity directly or indirectly owns, controls, or	808
holds with power to vote, twenty per cent or more of the	809
outstanding voting securities of the person who claims an	810
exemption, unless the entity holds the securities in a fiduciary	811
or agency capacity without sole discretionary power to vote the	812
securities or holds the securities solely to secure to debt and	813
the entity has not in fact exercised the power to vote.	814

(ii) The entity is a corporation, twenty per cent or more of	815
whose outstanding voting securities are directly or indirectly	816
owned, controlled, or held with power to vote, by the person who	817
claims an exemption or by an entity to which division (C)(2)(d)(i)	818
of this section applies.	819

(iii) A person whose business is operated under a lease or	820
operating agreement by the person who claims an exemption, or a	821
person substantially all of whose business is operated under an	822
operating agreement with the person who claims an exemption.	823

(iv) The entity operates the business or all or substantially	824
all of the property of the person who claims an exemption under a	825
lease or operating agreement.	826

(e) An insider, as otherwise defined in this section, of a	827
person or entity to which division (C)(2)(d)(i), (ii), (iii), or	828
(iv) of this section applies, as if the person or entity were a	829
person who claims an exemption;	830

(f) A managing agent of the person who claims an exemption.

831

(3) "Participant account" has the same meaning as in section	832
148.01 of the Revised Code.	833

(4) "Government unit" has the same meaning as in section	834
148.06 of the Revised Code.	835

(D) For purposes of this section, "interest" shall be	836
determined as follows:	837

(1) In bankruptcy proceedings, as of the date a petition is	838
filed with the bankruptcy court commencing a case under Title 11	839
of the United States Code;	840

(2) In all cases other than bankruptcy proceedings, as of the	841
date of an appraisal, if necessary under section 2329.68 of the	842
Revised Code, or the issuance of a writ of execution.	843

An interest, as determined under division (D)(1) or (2) of	844
this section, shall not include the amount of any lien otherwise	845
valid pursuant to section 2329.661 of the Revised Code.	846

Sec. 3769.21.  (A) A corporation may be formed pursuant to	847
Chapter 1702. of the Revised Code to establish a thoroughbred	848
horsemen's health and retirement fund and a corporation may be	849
formed pursuant to Chapter 1702. of the Revised Code to establish	850
a harness horsemen's health and retirement fund to be administered	851
for the benefit of horsemen. As used in this section, "horsemen"	852
includes any person involved in the owning, breeding, training,	853
grooming, or racing of horses which race in Ohio, except for the	854
owners or managers of race tracks. For purposes of the	855
thoroughbred horsemen's health and retirement fund, "horsemen"	856
also does not include trainers and grooms who are not members of	857
the thoroughbred horsemen's organization in this state. No more	858
than one corporation to establish a thoroughbred horsemen's health	859
and retirement fund and no more than one corporation to establish	860
a harness horsemen's health and retirement fund may be established	861
in Ohio pursuant to this section. The trustees of the corporation	862
formed to establish a thoroughbred horsemen's health and	863
retirement fund shall have the discretion to determine which	864
horsemen shall benefit from such fund.	865

(B) The articles of incorporation of both of the corporations	866
described in division (A) of this section shall provide for at	867
least the following:	868

(1) The corporation shall be governed by, and the health and	869
retirement fund shall be administered by, a board of three	870
trustees appointed pursuant to division (C) of this section for	871
staggered three-year terms.	872

(2) The board of trustees shall adopt and administer a plan	873
to provide health benefits, retirement benefits, or both to either	874
thoroughbred or harness horsemen.	875

(3) The sum paid to the corporation pursuant to division (G)	876
or (H) of section 3769.08 of the Revised Code and the video	877
lottery terminal revenue paid to the corporation pursuant to	878
section 3769.087 of the Revised Code shall be used exclusively to	879
establish and administer the health and retirement fund, and to	880
finance benefits paid to horsemen pursuant to the plan adopted	881
under division (B)(2) of this section.	882

(4) The articles of incorporation and code of regulations of	883
the corporation may be amended at any time by the board of	884
trustees pursuant to the method set forth in the articles of	885
incorporation and code of regulations, except that no amendment	886
shall be adopted which is inconsistent with this section.	887

(C) Within sixty days after the formation of each of the	888
corporations described in division (A) of this section, the state	889
racing commission shall appoint the members of the board of	890
trustees of that corporation. Vacancies shall be filled by the	891
state racing commission in the same manner as initial	892
appointments. Each trustee of the thoroughbred horsemen's health	893
and retirement fund appointed by the commission shall be active as	894
a thoroughbred horseman while serving a term as a trustee and	895
shall have been active as a thoroughbred horseman for at least	896
five years immediately prior to the commencement of any such term.	897
Each trustee of the harness horsemen's health and retirement fund	898
appointed by the commission shall be active as a harness horseman	899
while serving a term as a trustee and shall have been active as a	900
harness horseman for at least five years immediately prior to the	901
commencement of any such term. The incorporators of either such	902
corporation may serve as initial trustees until the state racing	903
commission acts pursuant to this section to make these	904
appointments.	905

(D) The intent of the general assembly in enacting this	906
section pursuant to Amended House Bill No. 639 of the 115th	907
general assembly was to fulfill a legitimate government	908
responsibility in a manner that would be more cost efficient and	909
effective than direct state agency administration by permitting	910
nonprofit corporations to be formed to establish health and	911
retirement funds for the benefit of harness and thoroughbred	912
horsemen, as it was determined that such persons were in need of	913
such benefits.	914

Sec. 3923.022.  (A) As used in this section:

915

(1)(a) "Administrative expense" means the amount resulting	916
from the following: the amount of premiums earned by the insurer	917
for sickness and accident insurance business plus the amount of	918
losses recovered from reinsurance coverage minus the sum of the	919
amount of claims for losses paid; the amount of losses incurred	920
but not reported; the amount incurred for state fees, federal and	921
state taxes, and reinsurance; and the incurred costs and expenses	922
related, either directly or indirectly, to the payment of	923
commissions, measures to control fraud, and managed care.	924

(b) "Administrative expense" does not include any amounts	925
collected, or administrative expenses incurred, by an insurer for	926
the administration of an employee health benefit plan subject to	927
regulation by the federal "Employee Retirement Income Security Act	928
of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended. "Amounts	929
collected or administrative expenses incurred" means the total	930
amount paid to an administrator for the administration and payment	931
of claims minus the sum of the amount of claims for losses paid	932
and the amount of losses incurred but not reported.	933

(2) "Insurer" means any insurance company authorized under	934
Title XXXIX of the Revised Code to do the business of sickness and	935
accident insurance in this state.	936

(3) "Sickness and accident insurance business" does not	937
include coverage provided by an insurer for specific diseases or	938
accidents only; any hospital indemnity, medicare supplement,	939
long-term care, disability income, one-time-limited-duration	940
policy of no longerthat is less than sixtwelve months, or other	941
policy that offers only supplemental benefits; or coverage	942
provided to individuals who are not residents of this state.	943

(4) "Individual business" includes both individual sickness	944
and accident insurance and sickness and accident insurance made	945
available by insurers in the individual market to individuals,	946
with or without family members or dependents, through group	947
policies issued to one or more associations or entities.	948

(B) Notwithstanding section 3941.14 of the Revised Code, each	949
insurer shall have aggregate administrative expenses of no more	950
than twenty per cent of the premium income of the insurer, based	951
on the premiums earned in that year on the sickness and accident	952
insurance business of the insurer.	953

(C)(1) Each insurer, on the first day of January or within	954
sixty days thereafter, shall annually prepare, under oath, and	955
deposit in the office of the superintendent of insurance a	956
statement of the aggregate administrative expenses of the insurer,	957
based on the premiums earned in the immediately preceding calendar	958
year on the sickness and accident insurance business of the	959
insurer. The statement shall itemize and separately detail all of	960
the following information with respect to the insurer's sickness	961
and accident insurance business:	962

(a) The amount of premiums earned by the insurer both before	963
and after any costs related to the insurer's purchase of	964
reinsurance coverage;	965

(b) The total amount of claims for losses paid by the insurer	966
both before and after any reimbursement from reinsurance coverage;	967

(c) The amount of any losses incurred by the insurer but not	968
reported by the insurer in the current or prior year;	969

(d) The amount of costs incurred by the insurer for state	970
fees and federal and state taxes;	971

(e) The amount of costs incurred by the insurer for	972
reinsurance coverage;	973

(f) The amount of costs incurred by the insurer that are	974
related to the insurer's payment of commissions;	975

(g) The amount of costs incurred by the insurer that are	976
related to the insurer's fraud prevention measures;	977

(h) The amount of costs incurred by the insurer that are	978
related to managed care; and	979

(i) Any other administrative expenses incurred by the	980
insurer.	981

(2) The statement also shall include all of the information	982
required under division (C)(1) of this section separately detailed	983
for the insurer's individual business, small group business, and	984
large group business.	985

(D) No insurer shall fail to comply with this section.

986

(E) If the superintendent determines that an insurer has	987
violated this section, the superintendent, pursuant to an	988
adjudication conducted in accordance with Chapter 119. of the	989
Revised Code, may order the suspension of the insurer's license to	990
do the business of sickness and accident insurance in this state	991
until the superintendent is satisfied that the insurer is in	992
compliance with this section. If the insurer continues to do the	993
business of sickness and accident insurance in this state while	994
under the suspension order, the superintendent shall order the	995
insurer to pay one thousand dollars for each day of the violation.	996

(F) Any money collected by the superintendent under division	997
(E) of this section shall be deposited by the superintendent into	998
the state treasury to the credit of the department of insurance	999
operating fund.	1000

(G) The statement of aggregate expenses filed pursuant to	1001
this section separately detailing an insurer's individual, small	1002
group, and large group business shall be considered work papers	1003
resulting from the conduct of a market analysis of an entity	1004
subject to examination by the superintendent under division (C) of	1005
section 3901.48 of the Revised Code, except that the	1006
superintendent may share aggregated market information that	1007
identifies the premiums earned as reported under division	1008
(C)(1)(a) of this section, the administrative expenses reported	1009
under division (C)(1)(i) of this section, the amount of	1010
commissions reported under division (C)(1)(f) of this section, the	1011
amount of taxes paid as reported under division (C)(1)(d) of this	1012
section, the total of the remaining benefit costs as reported	1013
under divisions (C)(1)(b) and (c) of this section, and the amount	1014
of fraud and managed care expenses reported under divisions	1015
(C)(1)(g) and (h) of this section.	1016

Sec. 3923.24.  (A) Notwithstanding section 3901.71 of the	1017
Revised Code, every certificate furnished by an insurer in	1018
connection with, or pursuant to any provision of, any group	1019
sickness and accident insurance policy delivered, issued for	1020
delivery, renewed, or used in this state on or after January 1,	1021
1972, every policy of sickness and accident insurance delivered,	1022
issued for delivery, renewed, or used in this state on or after	1023
January 1, 1972, and every multiple employer welfare arrangement	1024
offering an insurance program, which provides that coverage of an	1025
unmarried dependent child of a parent or legal guardian will	1026
terminate upon attainment of the limiting age for dependent	1027
children specified in the contract shall also provide in substance	1028
both of the following:	1029

(1) Once an unmarried child has attained the limiting age for	1030
dependent children, as provided in the policy, upon the request of	1031
the insured, the insurer shall offer to cover the unmarried child	1032
until the child attains twenty-eighttwenty-six years of age if	1033
all of the following are true:	1034

(a) The child is the natural child, stepchild, or adopted	1035
child of the insured.	1036

(b) The child is a resident of this state or a full-time	1037
student at an accredited public or private institution of higher	1038
education.	1039

(c) The child is not employed by an employer that offers any	1040
health benefit plan under which the child is eligible for	1041
coverage.	1042

(d) The child is not eligible for the medicaid program or the	1043
medicare program.	1044

(2) That attainment of the limiting age for dependent	1045
children shall not operate to terminate the coverage of a	1046
dependent child if the child is and continues to be both of the	1047
following:	1048

(a) Incapable of self-sustaining employment by reason of	1049
mental retardation or physical handicap;	1050

(b) Primarily dependent upon the policyholder or certificate	1051
holder for support and maintenance.	1052

(B) Proof of such incapacity and dependence for purposes of	1053
division (A)(2) of this section shall be furnished by the	1054
policyholder or by the certificate holder to the insurer within	1055
thirty-one days of the child's attainment of the limiting age.	1056
Upon request, but not more frequently than annually after the	1057
two-year period following the child's attainment of the limiting	1058
age, the insurer may require proof satisfactory to it of the	1059
continuance of such incapacity and dependency.	1060

(C) Nothing in this section shall require an insurer to cover	1061
a dependent child who is mentally retarded or physically	1062
handicapped if the contract is underwritten on evidence of	1063
insurability based on health factors set forth in the application,	1064
or if such dependent child does not satisfy the conditions of the	1065
contract as to any requirement for evidence of insurability or	1066
other provision of the contract, satisfaction of which is required	1067
for coverage thereunder to take effect. In any such case, the	1068
terms of the contract shall apply with regard to the coverage or	1069
exclusion of the dependent from such coverage. Nothing in this	1070
section shall apply to accidental death or dismemberment benefits	1071
provided by any such policy of sickness and accident insurance.	1072

(D) Nothing in this section shall do any of the following:

1073

(1) Require that any policy offer coverage for dependent	1074
children or provide coverage for an unmarried dependent child's	1075
children as dependents on the policy;	1076

(2) Require an employer to pay for any part of the premium	1077
for an unmarried dependent child that has attained the limiting	1078
age for dependents, as provided in the policy;	1079

(3) Require an employer to offer health insurance coverage to	1080
the dependents of any employee.	1081

(E) This section does not apply to any policies or	1082
certificates covering only accident, credit, dental, disability	1083
income, long-term care, hospital indemnity, medicare supplement,	1084
specified disease, or vision care; coverage under a	1085
one-time-limited-duration policy of not longerthat is less than	1086
sixtwelve months; coverage issued as a supplement to liability	1087
insurance; insurance arising out of a workers' compensation or	1088
similar law; automobile medical-payment insurance; or insurance	1089
under which benefits are payable with or without regard to fault	1090
and that is statutorily required to be contained in any liability	1091
insurance policy or equivalent self-insurance.	1092

(F) As used in this section, "health benefit plan" has the	1093
same meaning as in section 3924.01 of the Revised Code and also	1094
includes both of the following:	1095

(1) A public employee benefit plan;

1096

(2) A health benefit plan as regulated under the "Employee	1097
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	1098

Sec. 3923.241. (A) Notwithstanding section 3901.71 of the	1099
Revised Code, any public employee benefit plan that provides that	1100
coverage of an unmarried dependent child will terminate upon	1101
attainment of the limiting age for dependent children specified in	1102
the plan shall also provide in substance both of the following:	1103

(1) Once an unmarried child has attained the limiting age for	1104
dependent children, as provided in the plan, upon the request of	1105
the employee, the public employee benefit plan shall offer to	1106
cover the unmarried child until the child attains twenty-eight	1107
twenty-six years of age if all of the following are true:	1108

(a) The child is the natural child, stepchild, or adopted	1109
child of the employee.	1110

(b) The child is a resident of this state or a full-time	1111
student at an accredited public or private institution of higher	1112
education.	1113

(c) The child is not employed by an employer that offers any	1114
health benefit plan under which the child is eligible for	1115
coverage.	1116

(d) The child is not eligible for the medicaid program or the	1117
medicare program.	1118

(2) That attainment of the limiting age for dependent	1119
children shall not operate to terminate the coverage of a	1120
dependent child if the child is and continues to be both of the	1121
following:	1122

(a) Incapable of self-sustaining employment by reason of	1123
mental retardation or physical handicap;	1124

(b) Primarily dependent upon the plan member for support and	1125
maintenance.	1126

(B) Proof of incapacity and dependence for purposes of	1127
division (A)(2) of this section shall be furnished to the public	1128
employee benefit plan within thirty-one days of the child's	1129
attainment of the limiting age. Upon request, but not more	1130
frequently than annually, the public employee benefit plan may	1131
require proof satisfactory to it of the continuance of such	1132
incapacity and dependency.	1133

(C) Nothing in this section shall do any of the following:

1134

(1) Require that any public employee benefit plan offer	1135
coverage for dependent children or provide coverage for an	1136
unmarried dependent child's children as dependents on the public	1137
employee benefit plan;	1138

(2) Require an employer to pay for any part of the premium	1139
for an unmarried dependent child that has attained the limiting	1140
age for dependents, as provided in the plan;	1141

(3) Require an employer to offer health insurance coverage to	1142
the dependents of any employee.	1143

(D) This section does not apply to any public employee	1144
benefit plan covering only accident, credit, dental, disability	1145
income, long-term care, hospital indemnity, medicare supplement,	1146
specified disease, or vision care; coverage under a	1147
one-time-limited-duration policy of not longerthat is less than	1148
sixtwelve months; coverage issued as a supplement to liability	1149
insurance; insurance arising out of a workers' compensation or	1150
similar law; automobile medical-payment insurance; or insurance	1151
under which benefits are payable with or without regard to fault	1152
and which is statutorily required to be contained in any liability	1153
insurance policy or equivalent self-insurance.	1154

(E) As used in this section, "health benefit plan" has the	1155
same meaning as in section 3924.01 of the Revised Code and also	1156
includes both of the following:	1157

(1) A public employee benefit plan;

1158

(2) A health benefit plan as regulated under the "Employee	1159
Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq.	1160

Sec. 3923.281.  (A) As used in this section:

1161

(1) "Biologically based mental illness" means schizophrenia,	1162
schizoaffective disorder, major depressive disorder, bipolar	1163
disorder, paranoia and other psychotic disorders,	1164
obsessive-compulsive disorder, and panic disorder, as these terms	1165
are defined in the most recent edition of the diagnostic and	1166
statistical manual of mental disorders published by the American	1167
psychiatric association.	1168

(2) "Policy of sickness and accident insurance" has the same	1169
meaning as in section 3923.01 of the Revised Code, but excludes	1170
any hospital indemnity, medicare supplement, long-term care,	1171
disability income, one-time-limited-duration policy of not longer	1172
that is less than sixtwelve months, supplemental benefit, or	1173
other policy that provides coverage for specific diseases or	1174
accidents only; any policy that provides coverage for workers'	1175
compensation claims compensable pursuant to Chapters 4121. and	1176
4123. of the Revised Code; and any policy that provides coverage	1177
to medicaid recipients.	1178

(B) Notwithstanding section 3901.71 of the Revised Code, and	1179
subject to division (E) of this section, every policy of sickness	1180
and accident insurance shall provide benefits for the diagnosis	1181
and treatment of biologically based mental illnesses on the same	1182
terms and conditions as, and shall provide benefits no less	1183
extensive than, those provided under the policy of sickness and	1184
accident insurance for the treatment and diagnosis of all other	1185
physical diseases and disorders, if both of the following apply:	1186

(1) The biologically based mental illness is clinically	1187
diagnosed by a physician authorized under Chapter 4731. of the	1188
Revised Code to practice medicine and surgery or osteopathic	1189
medicine and surgery; a psychologist licensed under Chapter 4732.	1190
of the Revised Code; a licensed professional clinical counselor,	1191
licensed professional counselor, independent social worker, or	1192
independent marriage and family therapist licensed under Chapter	1193
4757. of the Revised Code; or a clinical nurse specialist or	1194
certified nurse practitioner licensed under Chapter 4723. of the	1195
Revised Code whose nursing specialty is mental health.	1196

(2) The prescribed treatment is not experimental or	1197
investigational, having proven its clinical effectiveness in	1198
accordance with generally accepted medical standards.	1199

(C) Division (B) of this section applies to all coverages and	1200
terms and conditions of the policy of sickness and accident	1201
insurance, including, but not limited to, coverage of inpatient	1202
hospital services, outpatient services, and medication; maximum	1203
lifetime benefits; copayments; and individual and family	1204
deductibles.	1205

(D) Nothing in this section shall be construed as prohibiting	1206
a sickness and accident insurance company from taking any of the	1207
following actions:	1208

(1) Negotiating separately with mental health care providers	1209
with regard to reimbursement rates and the delivery of health care	1210
services;	1211

(2) Offering policies that provide benefits solely for the	1212
diagnosis and treatment of biologically based mental illnesses;	1213

(3) Managing the provision of benefits for the diagnosis or	1214
treatment of biologically based mental illnesses through the use	1215
of pre-admission screening, by requiring beneficiaries to obtain	1216
authorization prior to treatment, or through the use of any other	1217
mechanism designed to limit coverage to that treatment determined	1218
to be necessary;	1219

(4) Enforcing the terms and conditions of a policy of	1220
sickness and accident insurance.	1221

(E) An insurer that offers any policy of sickness and	1222
accident insurance is not required to provide benefits for the	1223
diagnosis and treatment of biologically based mental illnesses	1224
pursuant to division (B) of this section if all of the following	1225
apply:	1226

(1) The insurer submits documentation certified by an	1227
independent member of the American academy of actuaries to the	1228
superintendent of insurance showing that incurred claims for	1229
diagnostic and treatment services for biologically based mental	1230
illnesses for a period of at least six months independently caused	1231
the insurer's costs for claims and administrative expenses for the	1232
coverage of all other physical diseases and disorders to increase	1233
by more than one per cent per year.	1234

(2) The insurer submits a signed letter from an independent	1235
member of the American academy of actuaries to the superintendent	1236
of insurance opining that the increase described in division	1237
(E)(1) of this section could reasonably justify an increase of	1238
more than one per cent in the annual premiums or rates charged by	1239
the insurer for the coverage of all other physical diseases and	1240
disorders.	1241

(3) The superintendent of insurance makes the following	1242
determinations from the documentation and opinion submitted	1243
pursuant to divisions (E)(1) and (2) of this section:	1244

(a) Incurred claims for diagnostic and treatment services for	1245
biologically based mental illnesses for a period of at least six	1246
months independently caused the insurer's costs for claims and	1247
administrative expenses for the coverage of all other physical	1248
diseases and disorders to increase by more than one per cent per	1249
year.	1250

(b) The increase in costs reasonably justifies an increase of	1251
more than one per cent in the annual premiums or rates charged by	1252
the insurer for the coverage of all other physical diseases and	1253
disorders.	1254

Any determination made by the superintendent under this	1255
division is subject to Chapter 119. of the Revised Code.	1256

Sec. 3923.57.  Notwithstanding any provision of this chapter,	1257
every individual policy of sickness and accident insurance that is	1258
delivered, issued for delivery, or renewed in this state is	1259
subject to the following conditions, as applicable:	1260

(A) Pre-existing conditions provisions shall not exclude or	1261
limit coverage for a period beyond twelve months following the	1262
policyholder's effective date of coverage and may only relate to	1263
conditions during the six months immediately preceding the	1264
effective date of coverage.	1265

(B) In determining whether a pre-existing conditions	1266
provision applies to a policyholder or dependent, each policy	1267
shall credit the time the policyholder or dependent was covered	1268
under a previous policy, contract, or plan if the previous	1269
coverage was continuous to a date not more than thirty days prior	1270
to the effective date of the new coverage, exclusive of any	1271
applicable service waiting period under the policy.	1272

(C)(1) Except as otherwise provided in division (C) of this	1273
section, an insurer that provides an individual sickness and	1274
accident insurance policy to an individual shall renew or continue	1275
in force such coverage at the option of the individual.	1276

(2) An insurer may nonrenew or discontinue coverage of an	1277
individual in the individual market based only on one or more of	1278
the following reasons:	1279

(a) The individual failed to pay premiums or contributions in	1280
accordance with the terms of the policy or the insurer has not	1281
received timely premium payments.	1282

(b) The individual performed an act or practice that	1283
constitutes fraud or made an intentional misrepresentation of	1284
material fact under the terms of the policy.	1285

(c) The insurer is ceasing to offer coverage in the	1286
individual market in accordance with division (D) of this section	1287
and the applicable laws of this state.	1288

(d) If the insurer offers coverage in the market through a	1289
network plan, the individual no longer resides, lives, or works in	1290
the service area, or in an area for which the insurer is	1291
authorized to do business; provided, however, that such coverage	1292
is terminated uniformly without regard to any health	1293
status-related factor of covered individuals.	1294

(e) If the coverage is made available in the individual	1295
market only through one or more bona fide associations, the	1296
membership of the individual in the association, on the basis of	1297
which the coverage is provided, ceases; provided, however, that	1298
such coverage is terminated under division (C)(2)(e) of this	1299
section uniformly without regard to any health status-related	1300
factor of covered individuals.	1301

An insurer offering coverage to individuals solely through	1302
membership in a bona fide association shall not be deemed, by	1303
virtue of that offering, to be in the individual market for	1304
purposes of sections 3923.58 and 3923.581 of the Revised Code.	1305
Such an insurer shall not be required to accept applicants for	1306
coverage in the individual market pursuant to sections 3923.58 and	1307
3923.581 of the Revised Code unless the insurer also offers	1308
coverage to individuals other than through bona fide associations.	1309

(3) An insurer may cancel or decide not to renew the coverage	1310
of a dependent of an individual if the dependent has performed an	1311
act or practice that constitutes fraud or made an intentional	1312
misrepresentation of material fact under the terms of the coverage	1313
and if the cancellation or nonrenewal is not based, either	1314
directly or indirectly, on any health status-related factor in	1315
relation to the dependent.	1316

(D)(1) If an insurer decides to discontinue offering a	1317
particular type of health insurance coverage offered in the	1318
individual market, coverage of such type may be discontinued by	1319
the insurer if the insurer does all of the following:	1320

(a) Provides notice to each individual provided coverage of	1321
this type in such market of the discontinuation at least ninety	1322
days prior to the date of the discontinuation of the coverage;	1323

(b) Offers to each individual provided coverage of this type	1324
in such market, the option to purchase any other individual health	1325
insurance coverage currently being offered by the insurer for	1326
individuals in that market;	1327

(c) In exercising the option to discontinue coverage of this	1328
type and in offering the option of coverage under division	1329
(D)(1)(b) of this section, acts uniformly without regard to any	1330
health status-related factor of covered individuals or of	1331
individuals who may become eligible for such coverage.	1332

(2) If an insurer elects to discontinue offering all health	1333
insurance coverage in the individual market in this state, health	1334
insurance coverage may be discontinued by the insurer only if both	1335
of the following apply:	1336

(a) The insurer provides notice to the department of	1337
insurance and to each individual of the discontinuation at least	1338
one hundred eighty days prior to the date of the expiration of the	1339
coverage.	1340

(b) All health insurance delivered or issued for delivery in	1341
this state in such market is discontinued and coverage under that	1342
health insurance in that market is not renewed.	1343

(3) In the event of a discontinuation under division (D)(2)	1344
of this section in the individual market, the insurer shall not	1345
provide for the issuance of any health insurance coverage in the	1346
market and this state during the five-year period beginning on the	1347
date of the discontinuation of the last health insurance coverage	1348
not so renewed.	1349

(E) Notwithstanding divisions (C) and (D) of this section, an	1350
insurer may, at the time of coverage renewal, modify the health	1351
insurance coverage for a policy form offered to individuals in the	1352
individual market if the modification is consistent with the law	1353
of this state and effective on a uniform basis among all	1354
individuals with that policy form.	1355

(F) Such policies are subject to sections 2743 and 2747 of	1356
the "Health Insurance Portability and Accountability Act of 1996,"	1357
Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg-43 and	1358
300gg-47, as amended.	1359

(G) Sections 3924.031 and 3924.032 of the Revised Code shall	1360
apply to sickness and accident insurance policies offered in the	1361
individual market in the same manner as they apply to health	1362
benefit plans offered in the small employer market.	1363

In accordance with 45 C.F.R. 148.102, divisions (C) to (G) of	1364
this section also apply to all group sickness and accident	1365
insurance policies that are not sold in connection with an	1366
employment-related group health plan and that provide more than	1367
short-term, limited duration coverage.	1368

In applying divisions (C) to (G) of this section with respect	1369
to health insurance coverage that is made available by an insurer	1370
in the individual market to individuals only through one or more	1371
associations, the term "individual" includes the association of	1372
which the individual is a member.	1373

For purposes of this section, any policy issued pursuant to	1374
division (C) of section 3923.13 of the Revised Code in connection	1375
with a public or private college or university student health	1376
insurance program is considered to be issued to a bona fide	1377
association.	1378

As used in this section, "bona fide association" has the same	1379
meaning as in section 3924.03 of the Revised Code, and "health	1380
status-related factor" and "network plan" have the same meanings	1381
as in section 3924.031 of the Revised Code.	1382

This section does not apply to any policy that provides	1383
coverage for specific diseases or accidents only, or to any	1384
hospital indemnity, medicare supplement, long-term care,	1385
disability income, one-time-limited-duration policy of no longer	1386
that is less than sixtwelve months, or other policy that offers	1387
only supplemental benefits.	1388

Sec. 3923.58.  (A) As used in sections 3923.58 and 3923.59 of	1389
the Revised Code:	1390

(1) "Base rate" means, as to any health benefit plan that is	1391
issued by a carrier in the individual market, the lowest premium	1392
rate for new or existing business prescribed by the carrier for	1393
the same or similar coverage under a plan or arrangement covering	1394
any individual with similar case characteristics.	1395

(2) "Carrier," "health benefit plan," and "MEWA" have the	1396
same meanings as in section 3924.01 of the Revised Code.	1397

(3) "Network plan" means a health benefit plan of a carrier	1398
under which the financing and delivery of medical care, including	1399
items and services paid for as medical care, are provided, in	1400
whole or in part, through a defined set of providers under	1401
contract with the carrier.	1402

(4) "Ohio health care basic and standard plans" means those	1403
plans established under section 3924.10 of the Revised Code.	1404

(5) "Pre-existing conditions provision" means a policy	1405
provision that excludes or limits coverage for charges or expenses	1406
incurred during a specified period following the insured's	1407
effective date of coverage as to a condition which, during a	1408
specified period immediately preceding the effective date of	1409
coverage, had manifested itself in such a manner as would cause an	1410
ordinarily prudent person to seek medical advice, diagnosis, care,	1411
or treatment or for which medical advice, diagnosis, care, or	1412
treatment was recommended or received, or a pregnancy existing on	1413
the effective date of coverage.	1414

(B) Beginning in January of each year, carriers in the	1415
business of issuing health benefit plans to individuals and	1416
nonemployer groups, except individual health benefit plans issued	1417
pursuant to sections 1751.16 and 3923.122 of the Revised Code,	1418
shall accept applicants for open enrollment coverage, as set forth	1419
in this division, in the order in which they apply for coverage	1420
and subject to the limitation set forth in division (G) of this	1421
section. Carriers shall accept for coverage pursuant to this	1422
section individuals to whom both of the following conditions	1423
apply:	1424

(1) The individual is not applying for coverage as an	1425
employee of an employer, as a member of an association, or as a	1426
member of any other group.	1427

(2) The individual is not covered, and is not eligible for	1428
coverage, under any other private or public health benefits	1429
arrangement, including the medicare program established under	1430
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42	1431
U.S.C.A. 301, as amended, or any other act of congress or law of	1432
this or any other state of the United States that provides	1433
benefits comparable to the benefits provided under this section,	1434
any medicare supplement policy, or any continuation of coverage	1435
policy under state or federal law.	1436

(C) A carrier shall offer to any individual accepted under	1437
this section the Ohio health care basic and standard plans or	1438
health benefit plans that are substantially similar to the Ohio	1439
health care basic and standard plans in benefit plan design and	1440
scope of covered services.	1441

A carrier may offer other health benefit plans in addition	1442
to, but not in lieu of, the plans required to be offered under	1443
this division. A basic health benefit plan shall provide, at a	1444
minimum, the coverage provided by the Ohio health care basic plan	1445
or any health benefit plan that is substantially similar to the	1446
Ohio health care basic plan in benefit plan design and scope of	1447
covered services. A standard health benefit plan shall provide, at	1448
a minimum, the coverage provided by the Ohio health care standard	1449
plan or any health benefit plan that is substantially similar to	1450
the Ohio health care standard plan in benefit plan design and	1451
scope of covered services.	1452

For purposes of this division, the superintendent of	1453
insurance shall determine whether a health benefit plan is	1454
substantially similar to the Ohio health care basic and standard	1455
plans in benefit plan design and scope of covered services.	1456

(D)(1) Health benefit plans issued under this section may	1457
establish pre-existing conditions provisions that exclude or limit	1458
coverage for a period of up to twelve months following the	1459
individual's effective date of coverage and that may relate only	1460
to conditions during the six months immediately preceding the	1461
effective date of coverage. A health insuring corporation may	1462
apply a pre-existing condition provision for any basic health care	1463
service related to a transplant of a body organ if the transplant	1464
occurs within one year after the effective date of an enrollee's	1465
coverage under this section except with respect to a newly born	1466
child who meets the requirements for coverage under section	1467
1751.61 of the Revised Code.	1468

(2) In determining whether a pre-existing conditions	1469
provision applies to an insured or dependent, each policy shall	1470
credit the time the insured or dependent was covered under a	1471
previous policy, contract, or plan if the previous coverage was	1472
continuous to a date not more than sixty-three days prior to the	1473
effective date of the new coverage, exclusive of any applicable	1474
service waiting period under the policy.	1475

(E) Premiums charged to individuals under this section may	1476
not exceed the amounts specified below:	1477

(1) For calendar years 2010 and 2011, an amount that is two	1478
times the base rate for coverage offered to any other individual	1479
to which the carrier is currently accepting new business, and for	1480
which similar copayments and deductibles are applied;	1481

(2) For calendar year 2012 and every year thereafter, an	1482
amount that is one and one-half times the base rate for coverage	1483
offered to any other individual to which the carrier is currently	1484
accepting new business and for which similar copayments and	1485
deductibles are applied, unless the superintendent of insurance	1486
determines that the amendments by this act to this section and	1487
section 3923.581 of the Revised Code, have resulted in the	1488
market-wide average medical loss ratio for coverage sold to	1489
individual insureds and nonemployer group insureds in this state,	1490
including open enrollment insureds, to increase by more than five	1491
and one quarter percentage points during calendar year 2010. If	1492
the superintendent makes that determination, the premium limit	1493
established by division (E)(1) of this section shall remain in	1494
effect. The superintendent's determination shall be supported by a	1495
signed letter from a member of the American academy of actuaries.	1496

(F) In offering health benefit plans under this section, a	1497
carrier may require the purchase of health benefit plans that	1498
condition the reimbursement of health services upon the use of a	1499
specific network of providers.	1500

(G)(1) A carrier shall not be required to accept new	1501
applicants under this section if the total number of the carrier's	1502
current insureds with open enrollment coverage issued under this	1503
section calculated as of the immediately preceding thirty-first	1504
day of December and excluding the carrier's medicare supplement	1505
policies and conversion or continuation of coverage policies under	1506
state or federal law and any policies described in division (L) of	1507
this section meets the following limits:	1508

(a) For calendar years 2010 and 2011, four per cent of the	1509
carrier's total number of individual or nonemployer group insureds	1510
in this state;	1511

(b) For calendar year 2012 and every year thereafter, eight	1512
per cent of the carrier's total number of insured individuals and	1513
nonemployer group insureds in this state, unless the	1514
superintendent of insurance determines that the amendments by this	1515
act to this section and section 3923.581 of the Revised Code, have	1516
resulted in the market-wide average medical loss ratio for	1517
coverage sold to individual insureds and nonemployer group	1518
insureds in this state, including open enrollment insureds, to	1519
increase by more than five and one quarter percentage points	1520
during calendar year 2010. If the superintendent makes that	1521
determination, the enrollment limit established by division	1522
(G)(1)(a) of this section shall remain in effect. The	1523
superintendent's determination shall be supported by a signed	1524
letter from a member of the American academy of actuaries.	1525

(2) An officer of the carrier shall certify to the department	1526
of insurance when it has met the enrollment limit set forth in	1527
division (G)(1) of this section. Upon providing such	1528
certification, the carrier shall be relieved of its open	1529
enrollment requirement under this section as long as the carrier	1530
continues to meet the open enrollment limit. If the total number	1531
of the carrier's current insureds with open enrollment coverage	1532
issued under this section falls below the enrollment limit, the	1533
carrier shall accept new applicants. A carrier may establish a	1534
waiting list if the carrier has met the open enrollment limit and	1535
shall notify the superintendent if the carrier has a waiting list	1536
in effect.	1537

(H) A carrier shall not be required to accept under this	1538
section applicants who, at the time of enrollment, are confined to	1539
a health care facility because of chronic illness, permanent	1540
injury, or other infirmity that would cause economic impairment to	1541
the carrier if the applicants were accepted. A carrier shall not	1542
be required to make the effective date of benefits for individuals	1543
accepted under this section earlier than ninety days after the	1544
date of acceptance, except that when the individual had prior	1545
coverage with a health benefit plan that was terminated by a	1546
carrier because the carrier exited the market and the individual	1547
was accepted for open enrollment under this section within	1548
sixty-three days of that termination, the effective date of	1549
benefits shall be the date of enrollment.	1550

(I) The requirements of this section do not apply to any	1551
carrier that is currently in a state of supervision, insolvency,	1552
or liquidation. If a carrier demonstrates to the satisfaction of	1553
the superintendent that the requirements of this section would	1554
place the carrier in a state of supervision, insolvency, or	1555
liquidation, or would otherwise jeopardize the carrier's economic	1556
viability overall or in the individual market, the superintendent	1557
may waive or modify the requirements of division (B) or (G) of	1558
this section. The actions of the superintendent under this	1559
division shall be effective for a period of not more than one	1560
year. At the expiration of such time, a new showing of need for a	1561
waiver or modification by the carrier shall be made before a new	1562
waiver or modification is issued or imposed.	1563

(J) No hospital, health care facility, or health care	1564
practitioner, and no person who employs any health care	1565
practitioner, shall balance bill any individual or dependent of an	1566
individual for any health care supplies or services provided to	1567
the individual or dependent who is insured under a policy issued	1568
under this section. The hospital, health care facility, or health	1569
care practitioner, or any person that employs the health care	1570
practitioner, shall accept payments made to it by the carrier	1571
under the terms of the policy or contract insuring or covering	1572
such individual as payment in full for such health care supplies	1573
or services.	1574

As used in this division, "hospital" has the same meaning as	1575
in section 3727.01 of the Revised Code; "health care practitioner"	1576
has the same meaning as in section 4769.01 of the Revised Code;	1577
and "balance bill" means charging or collecting an amount in	1578
excess of the amount reimbursable or payable under the policy or	1579
health care service contract issued to an individual under this	1580
section for such health care supply or service. "Balance bill"	1581
does not include charging for or collecting copayments or	1582
deductibles required by the policy or contract.	1583

(K) A carrier may pay an agent a commission in the amount of	1584
not more than five per cent of the premium charged for initial	1585
placement or for otherwise securing the issuance of a policy or	1586
contract issued to an individual under this section, and not more	1587
than four per cent of the premium charged for the renewal of such	1588
a policy or contract. The superintendent may adopt, in accordance	1589
with Chapter 119. of the Revised Code, such rules as are necessary	1590
to enforce this division.	1591

(L) This section does not apply to any policy that provides	1592
coverage for specific diseases or accidents only, or to any	1593
hospital indemnity, medicare supplement, long-term care,	1594
disability income, one-time-limited-duration policy of no longer	1595
that is less than sixtwelve months, or other policy that offers	1596
only supplemental benefits.	1597

(M) If a carrier offers a health benefit plan in the	1598
individual market through a network plan, the carrier may do both	1599
of the following:	1600

(1) Limit the individuals that may apply for such coverage to	1601
those who live, work, or reside in the service area of the network	1602
plan;	1603

(2) Within the service area of the network plan, deny the	1604
coverage to individuals if the carrier has demonstrated both of	1605
the following to the superintendent:	1606

(a) The carrier will not have the capacity to deliver	1607
services adequately to any additional individuals because of the	1608
carrier's obligations to existing group contract holders and	1609
individuals.	1610

(b) The carrier is applying division (M)(2) of this section	1611
uniformly to all individuals without regard to any health	1612
status-related factors of those individuals.	1613

(N) A carrier that, pursuant to division (M)(2) of this	1614
section, denies coverage to an individual in the service area of a	1615
network plan, shall not offer coverage in the individual market	1616
within that service area for at least one hundred eighty days	1617
after the date the carrier denies the coverage.	1618

Sec. 3923.601. (A)(1) This section applies to both of the	1619
following:	1620

(a) A sickness and accident insurer that issues or requires	1621
the use of a standardized identification card or an electronic	1622
technology for submission and routing of prescription drug claims	1623
pursuant to a policy, contract, or agreement for health care	1624
services;	1625

(b) A person that a sickness and accident insurer contracts	1626
with to issue a standardized identification card or an electronic	1627
technology described in division (A)(1)(a) of this section.	1628

(2) Notwithstanding division (A)(1) of this section, this	1629
section does not apply to the issuance or required use of a	1630
standardized identification card or an electronic technology for	1631
the submission and routing of prescription drug claims in	1632
connection with any of the following:	1633

(a) Any individual or group policy of sickness and accident	1634
insurance covering only accident, credit, dental, disability	1635
income, long-term care, hospital indemnity, medicare supplement,	1636
medicare, tricare, specified disease, or vision care; coverage	1637
under a one-time-limited-duration policy of not longerthat is	1638
less than sixtwelve months; coverage issued as a supplement to	1639
liability insurance; insurance arising out of workers'	1640
compensation or similar law; automobile medical payment insurance;	1641
or insurance under which benefits are payable with or without	1642
regard to fault and which is statutorily required to be contained	1643
in any liability insurance policy or equivalent self-insurance.	1644

(b) Coverage provided under the medicaid program.

1645

(c) Coverage provided under an employer's self-insurance plan	1646
or by any of its administrators, as defined in section 3959.01 of	1647
the Revised Code, to the extent that federal law supersedes,	1648
preempts, prohibits, or otherwise precludes the application of	1649
this section to the plan and its administrators.	1650

(B) A standardized identification card or an electronic	1651
technology issued or required to be used as provided in division	1652
(A)(1) of this section shall contain uniform prescription drug	1653
information in accordance with either division (B)(1) or (2) of	1654
this section.	1655

(1) The standardized identification card or the electronic	1656
technology shall be in a format and contain information fields	1657
approved by the national council for prescription drug programs or	1658
a successor organization, as specified in the council's or	1659
successor organization's pharmacy identification card	1660
implementation guide in effect on the first day of October most	1661
immediately preceding the issuance or required use of the	1662
standardized identification card or the electronic technology.	1663

(2) If the insurer or person under contract with the insurer	1664
to issue a standardized identification card or an electronic	1665
technology requires the information for the submission and routing	1666
of a claim, the standardized identification card or the electronic	1667
technology shall contain any of the following information:	1668

(a) The insurer's name;

1669

(b) The insured's name, group number, and identification	1670
number;	1671

(c) A telephone number to inquire about pharmacy-related	1672
issues;	1673

(d) The issuer's international identification number, labeled	1674
as "ANSI BIN" or "RxBIN";	1675

(e) The processor's control number, labeled as "RxPCN";

1676

(f) The insured's pharmacy benefits group number if different	1677
from the insured's medical group number, labeled as "RxGrp."	1678

(C) If the standardized identification card or the electronic	1679
technology issued or required to be used as provided in division	1680
(A)(1) of this section is also used for submission and routing of	1681
nonpharmacy claims, the designation "Rx" is required to be	1682
included as part of the labels identified in divisions (B)(2)(d)	1683
and (e) of this section if the issuer's international	1684
identification number or the processor's control number is	1685
different for medical and pharmacy claims.	1686

(D) Each sickness and accident insurer described in division	1687
(A) of this section shall annually file a certificate with the	1688
superintendent of insurance certifying that it or any person it	1689
contracts with to issue a standardized identification card or	1690
electronic technology for submission and routing of prescription	1691
drug claims complies with this section.	1692

(E)(1) Except as provided in division (E)(2) of this section,	1693
if there is a change in the information contained in the	1694
standardized identification card or the electronic technology	1695
issued to an insured, the insurer or person under contract with	1696
the insurer to issue a standardized identification card or an	1697
electronic technology shall issue a new card or electronic	1698
technology to the insured.	1699

(2) An insurer or person under contract with the insurer is	1700
not required under division (E)(1) of this section to issue a new	1701
card or electronic technology to an insured more than once during	1702
a twelve-month period.	1703

(F) Nothing in this section shall be construed as requiring	1704
an insurer to produce more than one standardized identification	1705
card or one electronic technology for use by insureds accessing	1706
health care benefits provided under a policy of sickness and	1707
accident insurance.	1708

Sec. 3923.65.  (A) As used in this section:

1709

(1) "Emergency medical condition" means a medical condition	1710
that manifests itself by such acute symptoms of sufficient	1711
severity, including severe pain, that a prudent layperson with	1712
average knowledge of health and medicine could reasonably expect	1713
the absence of immediate medical attention to result in any of the	1714
following:	1715

(a) Placing the health of the individual or, with respect to	1716
a pregnant woman, the health of the woman or her unborn child, in	1717
serious jeopardy;	1718

(b) Serious impairment to bodily functions;

1719

(c) Serious dysfunction of any bodily organ or part.

1720

(2) "Emergency services" means the following:

1721

(a) A medical screening examination, as required by federal	1722
law, that is within the capability of the emergency department of	1723
a hospital, including ancillary services routinely available to	1724
the emergency department, to evaluate an emergency medical	1725
condition;	1726

(b) Such further medical examination and treatment that are	1727
required by federal law to stabilize an emergency medical	1728
condition and are within the capabilities of the staff and	1729
facilities available at the hospital, including any trauma and	1730
burn center of the hospital.	1731

(B) Every individual or group policy of sickness and accident	1732
insurance that provides hospital, surgical, or medical expense	1733
coverage shall cover emergency services without regard to the day	1734
or time the emergency services are rendered or to whether the	1735
policyholder, the hospital's emergency department where the	1736
services are rendered, or an emergency physician treating the	1737
policyholder, obtained prior authorization for the emergency	1738
services.	1739

(C) Every individual policy or certificate furnished by an	1740
insurer in connection with any sickness and accident insurance	1741
policy shall provide information regarding the following:	1742

(1) The scope of coverage for emergency services;

1743

(2) The appropriate use of emergency services, including the	1744
use of the 9-1-1 system and any other telephone access systems	1745
utilized to access prehospital emergency services;	1746

(3) Any copayments for emergency services.

1747

(D) This section does not apply to any individual or group	1748
policy of sickness and accident insurance covering only accident,	1749
credit, dental, disability income, long-term care, hospital	1750
indemnity, medicare supplement, medicare, tricare, specified	1751
disease, or vision care; coverage under a one-time limited	1752
duration policy of no longerthat is less than sixtwelve months;	1753
coverage issued as a supplement to liability insurance; insurance	1754
arising out of workers' compensation or similar law; automobile	1755
medical payment insurance; or insurance under which benefits are	1756
payable with or without regard to fault and which is statutorily	1757
required to be contained in any liability insurance policy or	1758
equivalent self-insurance.	1759

Sec. 3923.83. (A)(1) This section applies to both of the	1760
following:	1761

(a) A public employee benefit plan that issues or requires	1762
the use of a standardized identification card or an electronic	1763
technology for submission and routing of prescription drug claims	1764
pursuant to a policy, contract, or agreement for health care	1765
services;	1766

(b) A person or entity that a public employee benefit plan	1767
contracts with to issue a standardized identification card or an	1768
electronic technology described in division (A)(1)(a) of this	1769
section.	1770

(2) Notwithstanding division (A)(1) of this section, this	1771
section does not apply to the issuance or required use of a	1772
standardized identification card or an electronic technology for	1773
the submission and routing of prescription drug claims in	1774
connection with either of the following:	1775

(a) Any individual or group policy of insurance covering only	1776
accident, credit, dental, disability income, long-term care,	1777
hospital indemnity, medicare supplement, medicare, tricare,	1778
specified disease, or vision care; coverage under a	1779
one-time-limited-duration policy of not longerthat is less than	1780
sixtwelve months; coverage issued as a supplement to liability	1781
insurance; insurance arising out of workers' compensation or	1782
similar law; automobile medical payment insurance; or insurance	1783
under which benefits are payable with or without regard to fault	1784
and which is statutorily required to be contained in any liability	1785
insurance policy or equivalent self-insurance.	1786

(b) Coverage provided under the medicaid program.

1787

(B) A standardized identification card or an electronic	1788
technology issued or required to be used as provided in division	1789
(A)(1) of this section shall contain uniform prescription drug	1790
information in accordance with either division (B)(1) or (2) of	1791
this section.	1792

(1) The standardized identification card or the electronic	1793
technology shall be in a format and contain information fields	1794
approved by the national council for prescription drug programs or	1795
a successor organization, as specified in the council's or	1796
successor organization's pharmacy identification card	1797
implementation guide in effect on the first day of October most	1798
immediately preceding the issuance or required use of the	1799
standardized identification card or the electronic technology.	1800

(2) If the public employee benefit plan or person under	1801
contract with the plan to issue a standardized identification card	1802
or an electronic technology requires the information for the	1803
submission and routing of a claim, the standardized identification	1804
card or the electronic technology shall contain any of the	1805
following information:	1806

(a) The plan's name;

1807

(b) The insured's name, group number, and identification	1808
number;	1809

(c) A telephone number to inquire about pharmacy-related	1810
issues;	1811

(d) The issuer's international identification number, labeled	1812
as "ANSI BIN" or "RxBIN";	1813

(e) The processor's control number, labeled as "RxPCN";

1814

(f) The insured's pharmacy benefits group number if different	1815
from the insured's medical group number, labeled as "RxGrp."	1816

(C) If the standardized identification card or the electronic	1817
technology issued or required to be used as provided in division	1818
(A)(1) of this section is also used for submission and routing of	1819
nonpharmacy claims, the designation "Rx" is required to be	1820
included as part of the labels identified in divisions (B)(2)(d)	1821
and (e) of this section if the issuer's international	1822
identification number or the processor's control number is	1823
different for medical and pharmacy claims.	1824

(D)(1) Except as provided in division (D)(2) of this section,	1825
if there is a change in the information contained in the	1826
standardized identification card or the electronic technology	1827
issued to an insured, the public employee benefit plan or person	1828
under contract with the plan to issue a standardized	1829
identification card or electronic technology shall issue a new	1830
card or electronic technology to the insured.	1831

(2) A public employee benefit plan or person under contract	1832
with the plan is not required under division (D)(1) of this	1833
section to issue a new card or electronic technology to an insured	1834
more than once during a twelve-month period.	1835

(E) Nothing in this section shall be construed as requiring a	1836
public employee benefit plan to produce more than one standardized	1837
identification card or one electronic technology for use by	1838
insureds accessing health care benefits provided under a health	1839
benefit plan.	1840

Sec. 3923.85.  (A) As used in this section, "cost sharing"	1841
means the cost to an individual insured under an individual or	1842
group policy of sickness and accident insurance or a public	1843
employee benefit plan according to any coverage limit, copayment,	1844
coinsurance, deductible, or other out-of-pocket expense	1845
requirements imposed by the policy or plan.	1846

(B) Notwithstanding section 3901.71 of the Revised Code and	1847
subject to division (D) of this section, no individual or group	1848
policy of sickness and accident insurance that is delivered,	1849
issued for delivery, or renewed in this state and no public	1850
employee benefit plan that is established or modified in this	1851
state shall fail to comply with either of the following:	1852

(1) The policy or plan shall not provide coverage or impose	1853
cost sharing for a prescribed, orally administered cancer	1854
medication on a less favorable basis than the coverage it provides	1855
or cost sharing it imposes for intraveneously administered or	1856
injected cancer medications.	1857

(2) The policy or plan shall not comply with division (B)(1)	1858
of this section by imposing an increase in cost sharing solely for	1859
orally administered, intravenously administered, or injected	1860
cancer medications.	1861

(C) Notwithstanding any provision of this section to the	1862
contrary, a policy or plan shall be deemed to be in compliance	1863
with this section if the cost sharing imposed under such a policy	1864
or plan for orally administered cancer treatments does not exceed	1865
one hundred dollars per prescription fill. The cost sharing limit	1866
of one hundred dollars per prescription fill shall apply to a high	1867
deductible plan, as defined in 26 U.S.C. 223, or a catastrophic	1868
plan, as defined in 42 U.S.C. 18022, only after the deductible has	1869
been met.	1870

(D)(1) The prohibitions in division (B) of this section do	1871
not preclude an individual or group policy of sickness and	1872
accident insurance or public employee benefit plan from requiring	1873
an insured or plan member to obtain prior authorization before	1874
orally administered cancer medication is dispensed to the insured	1875
or plan member.	1876

(2) Division (B) of this section does not apply to the offer	1877
or renewal of any individual or group policy of sickness and	1878
accident insurance that provides coverage for specific diseases or	1879
accidents only, or to any hospital indemnity, medicare supplement,	1880
disability income, or other policy that offers only supplemental	1881
benefits.	1882

(E) An insurer that offers any sickness and accident	1883
insurance or any public employee benefit plan that offers coverage	1884
for basic health care services is not required to comply with	1885
division (B) of this section if all of the following apply:	1886

(1) The insurer or plan submits documentation certified by an	1887
independent member of the American academy of actuaries to the	1888
superintendent of insurance showing that compliance with division	1889
(B)(1) of this section for a period of at least six months	1890
independently caused the insurer or plan's costs for claims and	1891
administrative expenses for the coverage of basic health care	1892
services to increase by more than one per cent per year.	1893

(2) The insurer or plan submits a signed letter from an	1894
independent member of the American academy of actuaries to the	1895
superintendent of insurance opining that the increase in costs	1896
described in division (E)(1) of this section could reasonably	1897
justify an increase of more than one per cent in the annual	1898
premiums or rates charged by the insurer or plan for the coverage	1899
of basic health care services.	1900

(3)(a) The superintendent of insurance makes the following	1901
determinations from the documentation and opinion submitted	1902
pursuant to divisions (E)(1) and (2) of this section:	1903

(i) Compliance with division (B)(1) of this section for a	1904
period of at least six months independently caused the insurer or	1905
plan's costs for claims and administrative expenses for the	1906
coverage of basic health care services to increase more than one	1907
per cent per year.	1908

(ii) The increase in costs reasonably justifies an increase	1909
of more than one per cent in the annual premiums or rates charged	1910
by the insurer or plan for the coverage of basic health care	1911
services.	1912

(b) Any determination made by the superintendent under	1913
division (E)(3) of this section is subject to Chapter 119. of the	1914
Revised Code.	1915

Sec. 3924.01.  As used in sections 3924.01 to 3924.14 of the	1916
Revised Code:	1917

(A) "Actuarial certification" means a written statement	1918
prepared by a member of the American academy of actuaries, or by	1919
any other person acceptable to the superintendent of insurance,	1920
that states that, based upon the person's examination, a carrier	1921
offering health benefit plans to small employers is in compliance	1922
with sections 3924.01 to 3924.14 of the Revised Code. "Actuarial	1923
certification" shall include a review of the appropriate records	1924
of, and the actuarial assumptions and methods used by, the carrier	1925
relative to establishing premium rates for the health benefit	1926
plans.	1927

(B) "Adjusted average market premium price" means the average	1928
market premium price as determined by the board of directors of	1929
the Ohio health reinsurance program either on the basis of the	1930
arithmetic mean of all carriers' premium rates for an OHC plan	1931
sold to groups with similar case characteristics by all carriers	1932
selling OHC plans in the state, or on any other equitable basis	1933
determined by the board.	1934

(C) "Base premium rate" means, as to any health benefit plan	1935
that is issued by a carrier and that covers at least two but no	1936
more than fifty employees of a small employer, the lowest premium	1937
rate for a new or existing business prescribed by the carrier for	1938
the same or similar coverage under a plan or arrangement covering	1939
any small employer with similar case characteristics.	1940

(D) "Carrier" means any sickness and accident insurance	1941
company or health insuring corporation authorized to issue health	1942
benefit plans in this state or a MEWA. A sickness and accident	1943
insurance company that owns or operates a health insuring	1944
corporation, either as a separate corporation or as a line of	1945
business, shall be considered as a separate carrier from that	1946
health insuring corporation for purposes of sections 3924.01 to	1947
3924.14 of the Revised Code.	1948

(E) "Case characteristics" means, with respect to a small	1949
employer, the geographic area in which the employees work; the age	1950
and sex of the individual employees and their dependents; the	1951
appropriate industry classification as determined by the carrier;	1952
the number of employees and dependents; and such other objective	1953
criteria as may be established by the carrier. "Case	1954
characteristics" does not include claims experience, health	1955
status, or duration of coverage from the date of issue.	1956

(F) "Dependent" means the spouse or child of an eligible	1957
employee, subject to applicable terms of the health benefits plan	1958
covering the employee.	1959

(G) "Eligible employee" means an employee who works a normal	1960
work week of twenty-fivethirty or more hours. "Eligible employee"	1961
does not include a temporary or substitute employee, or a seasonal	1962
employee who works only part of the calendar year on the basis of	1963
natural or suitable times or circumstances.	1964

(H) "Health benefit plan" means any hospital or medical	1965
expense policy or certificate or any health plan provided by a	1966
carrier, that is delivered, issued for delivery, renewed, or used	1967
in this state on or after the date occurring six months after	1968
November 24, 1995. "Health benefit plan" does not include policies	1969
covering only accident, credit, dental, disability income,	1970
long-term care, hospital indemnity, medicare supplement, specified	1971
disease, or vision care; coverage under a	1972
one-time-limited-duration policy of no longerthat is less than	1973
sixtwelve months; coverage issued as a supplement to liability	1974
insurance; insurance arising out of a workers' compensation or	1975
similar law; automobile medical-payment insurance; or insurance	1976
under which benefits are payable with or without regard to fault	1977
and which is statutorily required to be contained in any liability	1978
insurance policy or equivalent self-insurance.	1979

(I) "Late enrollee" means an eligible employee or dependent	1980
who enrolls in a small employer's health benefit plan other than	1981
during the first period in which the employee or dependent is	1982
eligible to enroll under the plan or during a special enrollment	1983
period described in section 2701(f) of the "Health Insurance	1984
Portability and Accountability Act of 1996," Pub. L. No. 104-191,	1985
110 Stat. 1955, 42 U.S.C.A. 300gg, as amended.	1986

(J) "MEWA" means any "multiple employer welfare arrangement"	1987
as defined in section 3 of the "Federal Employee Retirement Income	1988
Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended,	1989
except for any arrangement which is fully insured as defined in	1990
division (b)(6)(D) of section 514 of that act.	1991

(K) "Midpoint rate" means, for small employers with similar	1992
case characteristics and plan designs and as determined by the	1993
applicable carrier for a rating period, the arithmetic average of	1994
the applicable base premium rate and the corresponding highest	1995
premium rate.	1996

(L) "Pre-existing conditions provision" means a policy	1997
provision that excludes or limits coverage for charges or expenses	1998
incurred during a specified period following the insured's	1999
enrollment date as to a condition for which medical advice,	2000
diagnosis, care, or treatment was recommended or received during a	2001
specified period immediately preceding the enrollment date.	2002
Genetic information shall not be treated as such a condition in	2003
the absence of a diagnosis of the condition related to such	2004
information.	2005

For purposes of this division, "enrollment date" means, with	2006
respect to an individual covered under a group health benefit	2007
plan, the date of enrollment of the individual in the plan or, if	2008
earlier, the first day of the waiting period for such enrollment.	2009

(M) "Service waiting period" means the period of time after	2010
employment begins before an employee is eligible to be covered for	2011
benefits under the terms of any applicable health benefit plan	2012
offered by the small employer.	2013

(N)(1) "Small employer" means, in connection with a group	2014
health benefit plan and with respect to a calendar year and a plan	2015
year, an employer who employed an average of at least two but no	2016
more than fifty eligible employees on business days during the	2017
preceding calendar year and who employs at least two employees on	2018
the first day of the plan year.	2019

(2) For purposes of division (N)(1) of this section, all	2020
persons treated as a single employer under subsection (b), (c),	2021
(m), or (o) of section 414 of the "Internal Revenue Code of 1986,"	2022
100 Stat. 2085, 26 U.S.C.A. 1, as amended, shall be considered one	2023
employer. In the case of an employer that was not in existence	2024
throughout the preceding calendar year, the determination of	2025
whether the employer is a small or large employer shall be based	2026
on the average number of eligible employees that it is reasonably	2027
expected the employer will employ on business days in the current	2028
calendar year. Any reference in division (N) of this section to an	2029
"employer" includes any predecessor of the employer. Except as	2030
otherwise specifically provided, provisions of sections 3924.01 to	2031
3924.14 of the Revised Code that apply to a small employer that	2032
has a health benefit plan shall continue to apply until the plan	2033
anniversary following the date the employer no longer meets the	2034
requirements of this division.	2035

(O) "OHC plan" means an Ohio health care plan, which is the	2036
basic, standard, or carrier reimbursement plan for small employers	2037
and individuals established in accordance with section 3924.10 of	2038
the Revised Code.	2039

Sec. 4729.291.  (A) When a licensed health professional	2040
authorized to prescribe drugs personally furnishes drugs to a	2041
patient pursuant to division (B) of section 4729.29 of the Revised	2042
Code, the prescriber shall ensure that the drugs are labeled and	2043
packaged in accordance with state and federal drug laws and any	2044
rules and regulations adopted pursuant to those laws. Records of	2045
purchase and disposition of all drugs personally furnished to	2046
patients shall be maintained by the prescriber in accordance with	2047
state and federal drug statutes and any rules adopted pursuant to	2048
those statutes.	2049

(B) When personally furnishing to a patient RU-486	2050
(mifepristone), a prescriber is subject to section 2919.123 of the	2051
Revised Code. A prescription for RU-486 (mifepristone) shall be in	2052
writing and in accordance with section 2919.123 of the Revised	2053
Code.	2054

(C)(1) Except as provided in division (D) of this section, a	2055
no prescriber may notshall do either of the following:	2056

(a) In any thirty-day period, personally furnish to or for	2057
patients, taken as a whole, controlled substances in an amount	2058
that exceeds a total of two thousand five hundred dosage units;	2059

(b) In any seventy-two-hour period, personally furnish to or	2060
for a patient an amount of a controlled substance that exceeds the	2061
amount necessary for the patient's use in a seventy-two-hour	2062
period.	2063

(2) The state board of pharmacy may impose a fine of not more	2064
than five thousand dollars on a prescriber who fails to comply	2065
with the limits established under division (C)(1) of this section.	2066
A separate fine may be imposed for each instance of failing to	2067
comply with the limits. In imposing the fine, the board's actions	2068
shall be taken in accordance with Chapter 119. of the Revised	2069
Code.	2070

(D)(1) None of the following shall be counted in determining	2071
whether the amounts specified in division (C)(1) of this section	2072
have been exceeded:	2073

(a) Methadone provided to patients for the purpose of	2074
treating drug dependence or addiction, if the prescriber meets the	2075
conditions specified in 21 C.F.R. 1306.07;	2076

(b) Buprenorphine provided to patients for the purpose of	2077
treating drug dependence or addiction, if the prescriber is exempt	2078
from separate registration with the United States drug enforcement	2079
administrationas part of an opioid treatment program that is the	2080
subject of a current, valid certification from the substance abuse	2081
and mental health services administration of the United States	2082
department of health and human services pursuant to 2142 C.F.R.	2083
1301.288.11 and distributes both buprenorphine and methadone;	2084

(c) Controlled substances provided to research subjects by a	2085
facility conducting clinical research in studies approved by a	2086
hospital-based institutional review board or an institutional	2087
review board accredited by the association for the accreditation	2088
of human research protection programs.	2089

(2) Division (C)(1) of this section does not apply to a	2090
prescriber who is a veterinarian.	2091

Sec. 4729.541.  (A) Except as provided in divisions (B) and	2092
(C) of this section, a business entity described in division	2093
(B)(1)(j) or (k) of section 4729.51 of the Revised Code may	2094
possess, have custody or control of, and distribute the dangerous	2095
drugs in category I, category II, and category III, as defined in	2096
section 4729.54 of the Revised Code, without holding a terminal	2097
distributor of dangerous drugs license issued under that section.	2098

(B) If a business entity described in division (B)(1)(j) or	2099
(k) of section 4729.51 of the Revised Code is a pain management	2100
clinic or is operating a pain management clinic, the entity shall	2101
hold a license as a terminal distributor of dangerous drugs with a	2102
pain management clinic classification issued under section	2103
4729.552 of the Revised Code.	2104

(C) Beginning April 1, 2015, a business entity described in	2105
division (B)(1)(j) or (k) of section 4729.51 of the Revised Code	2106
shall hold a license as a terminal distributor of dangerous drugs	2107
in order to possess, have custody or control of, and distribute	2108
dangerouseither of the following:	2109

(1) Dangerous drugs that are compounded or used for the	2110
purpose of compounding;	2111

(2) Controlled substances containing buprenorphine that are	2112
used for the purpose of treating drug dependence or addiction.	2113

Sec. 4731.056. (A) As used in this section:

2114

(1) "Controlled substance," "schedule III," "schedule IV,"	2115
and "schedule V" have the same meanings as in section 3719.01 of	2116
the Revised Code.	2117

(2) "Physician" means an individual authorized by this	2118
chapter to practice medicine and surgery or osteopathic medicine	2119
and surgery.	2120

(B) The state medical board shall adopt rules in accordance	2121
with Chapter 119. of the Revised Code that establish standards and	2122
procedures to be followed by physicians in the use of controlled	2123
substances in schedule III, IV, or V to treat opioid dependence or	2124
addiction. The board may limit the application of the rules to	2125
treatment provided through an office-based practice or other	2126
practice type or location specified by the board.	2127

Section 2.  That existing sections 1739.061, 1751.14,	2128
1751.69, 2329.66, 3769.21, 3923.022, 3923.24, 3923.241, 3923.281,	2129
3923.57, 3923.58, 3923.601, 3923.65, 3923.83, 3923.85, 3924.01,	2130
4729.291, and 4729.541 of the Revised Code are hereby repealed.	2131

Section 3. (A) Not later than thirty days after the effective	2132
date of this section, the legislative authority of the fund member	2133
described in section 143.02 of the Revised Code, as enacted by	2134
this act, that maintains the police or sheriff's department shall	2135
hold the initial election of members to a volunteer peace officers	2136
dependents' fund board. A board member shall serve an initial term	2137
of office beginning on the day after the member is elected to the	2138
board and ending on the thirty-first day of December of the year	2139
in which the member is elected. Thereafter, members shall be	2140
elected to the board and serve terms of office in accordance with	2141
section 143.02 of the Revised Code, as enacted by this act.	2142

(B) For the initial election of board members specified in	2143
division (A)(2) of section 143.02 of the Revised Code, the	2144
legislative authority of the fund member that maintains the police	2145
or sheriff's department shall do both of the following:	2146

(1) Give notice of the election by posting it in a	2147
conspicuous place at the headquarters of the police or sheriff's	2148
department. Between nine a.m. and nine p.m. on the day designated,	2149
each person eligible to vote shall send in writing the name of two	2150
persons eligible to be elected to the board who are the person's	2151
choices.	2152

(2) Count and record all votes cast at the election and	2153
announce the result. The two persons receiving the highest number	2154
of votes are elected. If there is a tie vote for any two persons,	2155
the election shall be decided by lot or in any other way agreed on	2156
by the persons for whom the tie vote was cast.	2157

Section 4. This act shall have no impact on the Public	2158
Employees Retirement System, Ohio Police and Fire Pension Fund, or	2159
State Highway Patrol Retirement System.	2160

Section 5. Section 1751.14 and division (G) of section	2161
3924.01 of the Revised Code, as amended by this act, apply only to	2162
policies, contracts, and agreements that are delivered, issued for	2163
delivery, or renewed in this state on or after January 1, 2016.	2164
Division (A)(1) of section 3923.24 and division (A)(1) of section	2165
3923.241 of the Revised Code, as amended by this act, apply only	2166
to policies of sickness and accident insurance delivered, issued	2167
for delivery, or renewed in this state and public employee benefit	2168
plans or multiple employer welfare arrangement contracts and	2169
certificates that are established or modified in this state on or	2170
after January 1, 2016.	2171

Section 6. The General Assembly declares that the amendments	2172
made to section 3923.58 of the Revised Code by this act are not to	2173
supersede the suspension of the operation of this section enacted	2174
by Section 3 of Sub. S.B. 9 of the 130th General Assembly. Rather,	2175
it is the intent of the General Assembly to ensure consistency in	2176
Ohio Insurance Law should this suspension be nullified.	2177

Section 7.  Section 2329.66 of the Revised Code is presented	2178
in this act as a composite of the section as amended by both Sub.	2179
H.B. 479 and Sub. S.B. 343 of the 129th General Assembly. The	2180
General Assembly, applying the principle stated in division (B) of	2181
section 1.52 of the Revised Code that amendments are to be	2182
harmonized if reasonably capable of simultaneous operation, finds	2183
that the composite is the resulting version of the section in	2184
effect prior to the effective date of the section as presented in	2185
this act.	2186