Bill Text: OH SB75 | 2013-2014 | 130th General Assembly | Introduced

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Bill Title: To prohibit health insurers from denying payment for a service during or after the performance of the service if the insurer provided prior written authorization for the service.

Spectrum: Slight Partisan Bill (Democrat 2-1)

Status: (Introduced - Dead) 2013-03-12 - To Insurance & Financial Institutions [SB75 Detail]

Download: Ohio-2013-SB75-Introduced.html

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As Introduced

130th General Assembly Regular Session 2013-2014

S. B. No. 75

Senator Tavares 

Cosponsors: Senators Seitz, Brown 

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A BILL

To amend section 1739.05 and to enact sections

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1751.76, 3923.71, and 3923.74 of the Revised Code

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to prohibit health insurers from denying payment

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for a service during or after the performance of

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the service if the insurer provided prior written

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authorization for the service.

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

Section 1. That section 1739.05 be amended and sections	7
1751.76, 3923.71, and 3923.74 of the Revised Code be enacted to	8
read as follows:	9

Sec. 1739.05.  (A) A multiple employer welfare arrangement	10
that is created pursuant to sections 1739.01 to 1739.22 of the	11
Revised Code and that operates a group self-insurance program may	12
be established only if any of the following applies:	13

(1) The arrangement has and maintains a minimum enrollment of	14
three hundred employees of two or more employers.	15

(2) The arrangement has and maintains a minimum enrollment of	16
three hundred self-employed individuals.	17

(3) The arrangement has and maintains a minimum enrollment of	18
three hundred employees or self-employed individuals in any	19
combination of divisions (A)(1) and (2) of this section.	20

(B) A multiple employer welfare arrangement that is created	21
pursuant to sections 1739.01 to 1739.22 of the Revised Code and	22
that operates a group self-insurance program shall comply with all	23
laws applicable to self-funded programs in this state, including	24
sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381	25
to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14,	26
3923.24, 3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63,	27
3923.74, 3923.80, 3924.031, 3924.032, and 3924.27 of the Revised	28
Code.	29

(C) A multiple employer welfare arrangement created pursuant	30
to sections 1739.01 to 1739.22 of the Revised Code shall solicit	31
enrollments only through agents or solicitors licensed pursuant to	32
Chapter 3905. of the Revised Code to sell or solicit sickness and	33
accident insurance.	34

(D) A multiple employer welfare arrangement created pursuant	35
to sections 1739.01 to 1739.22 of the Revised Code shall provide	36
benefits only to individuals who are members, employees of	37
members, or the dependents of members or employees, or are	38
eligible for continuation of coverage under section 1751.53 or	39
3923.38 of the Revised Code or under Title X of the "Consolidated	40
Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29	41
U.S.C.A. 1161, as amended.	42

Sec. 1751.76.  No health insuring corporation that agrees in	43
writing to provide coverage for the performance of a service prior	44
to the performance of the service shall deny payment for the	45
service during or after the performance of the service unless the	46
health insuring corporation's written agreement to provide	47
coverage for the service was based upon inaccurate information	48
provided to the health insuring corporation by the enrollee or	49
health care provider.	50

Sec. 3923.71.  No sickness and accident insurer that agrees	51
in writing to provide coverage for the performance of a service	52
prior to the performance of the service shall deny payment for the	53
service during or after the performance of the service unless the	54
insurer's written agreement to provide coverage for the service	55
was based upon inaccurate information provided to the insurer by	56
the insured or the health care provider.	57

Sec. 3923.74.  No public employee benefit plan that agrees in	58
writing to provide coverage for the performance of a service prior	59
to the performance of the service shall deny payment for the	60
service during or after the performance of the service unless the	61
public employee benefit plan's written agreement to provide	62
coverage for the service was based upon inaccurate information	63
provided to the public employee benefit plan by the plan member,	64
covered dependent, or health care provider.	65

Section 2. That existing section 1739.05 of the Revised Code	66
is hereby repealed.	67