Bill Text: OH HB172 | 2011-2012 | 129th General Assembly | Introduced

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Bill Title: To require the Superintendent of Insurance to post on the Department of Insurance's web site premium rates that are filed with the Superintendent by health insurers.

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Introduced - Dead) 2011-03-23 - To Insurance [HB172 Detail]

Download: Ohio-2011-HB172-Introduced.html

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As Introduced

129th General Assembly Regular Session 2011-2012

H. B. No. 172

Representative Hagan, R. 

Cosponsors: Representatives Foley, Ramos, Okey, Ashford, Williams, Letson, Antonio 

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A BILL

To amend sections 1751.12 and 3923.02 of the Revised

1

Code to require the Superintendent of Insurance to

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post on the Department of Insurance's web site

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premium rates that are filed with the

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Superintendent by health insurers.

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

Section 1. That sections 1751.12 and 3923.02 of the Revised	6
Code be amended to read as follows:	7

Sec. 1751.12.  (A)(1) No contractual periodic prepayment and	8
no premium rate for nongroup and conversion policies for health	9
care services, or any amendment to them, may be used by any health	10
insuring corporation at any time until the contractual periodic	11
prepayment and premium rate, or amendment, have been filed with	12
the superintendent of insurance, and shall not be effective until	13
the expiration of sixty days after their filing unless the	14
superintendent sooner gives approval. The filing shall be	15
accompanied by an actuarial certification in the form prescribed	16
by the superintendent. The superintendent shall disapprove the	17
filing, if the superintendent determines within the sixty-day	18
period that the contractual periodic prepayment or premium rate,	19
or amendment, is not in accordance with sound actuarial principles	20
or is not reasonably related to the applicable coverage and	21
characteristics of the applicable class of enrollees. The	22
superintendent shall notify the health insuring corporation of the	23
disapproval, and it shall thereafter be unlawful for the health	24
insuring corporation to use the contractual periodic prepayment or	25
premium rate, or amendment.	26

(2) No contractual periodic prepayment for group policies for	27
health care services shall be used until the contractual periodic	28
prepayment has been filed with the superintendent. The filing	29
shall be accompanied by an actuarial certification in the form	30
prescribed by the superintendent. The superintendent may reject a	31
filing made under division (A)(2) of this section at any time,	32
with at least thirty days' written notice to a health insuring	33
corporation, if the contractual periodic prepayment is not in	34
accordance with sound actuarial principles or is not reasonably	35
related to the applicable coverage and characteristics of the	36
applicable class of enrollees.	37

(3) At any time, the superintendent, upon at least thirty	38
days' written notice to a health insuring corporation, may	39
withdraw the approval given under division (A)(1) of this section,	40
deemed or actual, of any contractual periodic prepayment or	41
premium rate, or amendment, based on information that either of	42
the following applies:	43

(a) The contractual periodic prepayment or premium rate, or	44
amendment, is not in accordance with sound actuarial principles.	45

(b) The contractual periodic prepayment or premium rate, or	46
amendment, is not reasonably related to the applicable coverage	47
and characteristics of the applicable class of enrollees.	48

(4) Any disapproval under division (A)(1) of this section,	49
any rejection of a filing made under division (A)(2) of this	50
section, or any withdrawal of approval under division (A)(3) of	51
this section, shall be effected by a written notice, which shall	52
state the specific basis for the disapproval, rejection, or	53
withdrawal and shall be issued in accordance with Chapter 119. of	54
the Revised Code.	55

(5) Within three days of the superintendent's receipt of the	56
filing, the superintendent shall post any contractual periodic	57
prepayment or premium rate filed by a health insuring corporation	58
under division (A) of this section in the internet database	59
created by the superintendent under section 3923.02 of the Revised	60
Code.	61

(B) Notwithstanding division (A) of this section, a health	62
insuring corporation may use a contractual periodic prepayment or	63
premium rate for policies used for the coverage of beneficiaries	64
enrolled in medicare pursuant to a medicare risk contract or	65
medicare cost contract, or for policies used for the coverage of	66
beneficiaries enrolled in the federal employees health benefits	67
program pursuant to 5 U.S.C.A. 8905, or for policies used for the	68
coverage of medicaid recipients, or for policies used for coverage	69
of participants of the children's buy-in program, or for policies	70
used for the coverage of beneficiaries under any other federal	71
health care program regulated by a federal regulatory body, or for	72
policies used for the coverage of beneficiaries under any contract	73
covering officers or employees of the state that has been entered	74
into by the department of administrative services, if both of the	75
following apply:	76

(1) The contractual periodic prepayment or premium rate has	77
been approved by the United States department of health and human	78
services, the United States office of personnel management, the	79
department of job and family services, or the department of	80
administrative services.	81

(2) The contractual periodic prepayment or premium rate is	82
filed with the superintendent prior to use and is accompanied by	83
documentation of approval from the United States department of	84
health and human services, the United States office of personnel	85
management, the department of job and family services, or the	86
department of administrative services.	87

(C) The administrative expense portion of all contractual	88
periodic prepayment or premium rate filings submitted to the	89
superintendent for review must reflect the actual cost of	90
administering the product. The superintendent may require that the	91
administrative expense portion of the filings be itemized and	92
supported.	93

(D)(1) Copayments must be reasonable and must not be a	94
barrier to the necessary utilization of services by enrollees.	95

(2) A health insuring corporation, in order to ensure that	96
copayments are reasonable and not a barrier to the necessary	97
utilization of basic health care services by enrollees, may do one	98
of the following:	99

(a) Impose copayment charges on any single covered basic	100
health care service that does not exceed forty per cent of the	101
average cost to the health insuring corporation of providing the	102
service;	103

(b) Impose copayment charges that annually do not exceed	104
twenty per cent of the total annual cost to the health insuring	105
corporation of providing all covered basic health care services,	106
including physician office visits, urgent care services, and	107
emergency health services, when aggregated as to all persons	108
covered under the filed product in question. In addition, annual	109
copayment charges as to each enrollee shall not exceed twenty per	110
cent of the total annual cost to the health insuring corporation	111
of providing all covered basic health care services, including	112
physician office visits, urgent care services, and emergency	113
health services, as to such enrollee. The total annual cost of	114
providing a health care service is the cost to the health insuring	115
corporation of providing the health care service to its enrollees	116
as reduced by any applicable provider discount.	117

(3) To ensure that copayments are reasonable and not a	118
barrier to the utilization of basic health care services, a health	119
insuring corporation may not impose, in any contract year, on any	120
subscriber or enrollee, copayments that exceed two hundred per	121
cent of the average annual premium rate to subscribers or	122
enrollees.	123

(4) For purposes of division (D) of this section, both of the	124
following apply:	125

(a) Copayments imposed by health insuring corporations in	126
connection with a high deductible health plan that is linked to a	127
health savings account are reasonable and are not a barrier to the	128
necessary utilization of services by enrollees.	129

(b) Divisions (D)(2) and (3) of this section do not apply to	130
a high deductible health plan that is linked to a health savings	131
account.	132

(E) A health insuring corporation shall not impose lifetime	133
maximums on basic health care services. However, a health insuring	134
corporation may establish a benefit limit for inpatient hospital	135
services that are provided pursuant to a policy, contract,	136
certificate, or agreement for supplemental health care services.	137

(F) A health insuring corporation may require that an	138
enrollee pay an annual deductible that does not exceed one	139
thousand dollars per enrollee or two thousand dollars per family,	140
except that:	141

(1) A health insuring corporation may impose higher	142
deductibles for high deductible health plans that are linked to	143
health savings accounts;	144

(2) The superintendent may adopt rules allowing different	145
annual deductible amounts for plans with a medical savings	146
account, health reimbursement arrangement, flexible spending	147
account, or similar account;	148

(3) A health insuring corporation may impose higher	149
deductibles under health plans if requested by the group contract,	150
policy, certificate, or agreement holder, or an individual seeking	151
coverage under an individual health plan. This shall not be	152
construed as requiring the health insuring corporation to create	153
customized health plans for group contract holders or individuals.	154

(G) As used in this section, "health savings account" and	155
"high deductible health plan" have the same meanings as in the	156
"Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C. 223, as	157
amended.	158

Sec. 3923.02.  No certificate shall be furnished by any	159
insurer in connection with, or pursuant to any provision of, any	160
group sickness and accident insurance policy delivered, issued for	161
delivery, or used in this state, and no policy of sickness and	162
accident insurance shall be delivered, issued for delivery, or	163
used in this state, nor shall any indorsement, rider, or	164
application which becomes or which is designed to become a part of	165
any such policy or certificate be delivered, issued for delivery,	166
or used in this state, until a copy of the form of such policy,	167
certificate, indorsement, rider, or application and of the premium	168
rates and of the classification of risks pertaining thereto has	169
been filed with the superintendent of insurance. No such policy,	170
certificate, indorsement, rider or application shall be delivered,	171
issued for delivery, or used until the expiration of thirty days	172
after the form of such policy, certificate, indorsement, rider, or	173
application has been filed with the superintendent, unless hethe	174
superintendent has previously given to the insurer histhe	175
superintendent's written approval thereto. If the superintendent	176
finds that any such form of policy, certificate, indorsement,	177
rider, or application which has been filed with himthe	178
superintendent by an insurer contains any provision which is	179
contrary to the law of this state, or contains inconsistent	180
provisions, or contains any question, provision, title, heading,	181
backing, or other indication of its contents, which is ambiguous,	182
misleading, or deceptive, or likely to mislead or deceive the	183
policyholder, certificate holder or applicant, hethe	184
superintendent shall give written notice of histhat finding to	185
the insurer which has filed such form, and thereafter no insurer	186
which has filed such form shall deliver, issue for delivery, or	187
use such form in this state.	188

After the expiration of thirty days from the filing of any	189
such form, or at any time after the superintendent has given	190
written approval thereof, the superintendent may, after a hearing	191
of which at least twenty days' written notice has been given to	192
the insurer issuing such form, withdraw approval on any ground	193
stated in this section. Such disapproval shall be effected by	194
written order of the superintendent which shall state the ground	195
for disapproval and the date, not less than thirty days after such	196
hearing, when the withdrawal of approval shall become effective.	197
After the date when the withdrawal of approval of any such form	198
becomes effective, such form shall not be delivered, issued for	199
delivery, or used in this state. The form of any certificate	200
furnished by any insurer to a resident of this state in connection	201
with, or pursuant to any provisions of, any group sickness and	202
accident insurance policy which policy is not delivered, issued	203
for delivery, or used in this state but which insures residents of	204
this state shall, upon request of the superintendent, be filed	205
with the superintendent.	206

The superintendent shall post in an internet database on the	207
department of insurance's web site any premium rate filed in	208
connection with a policy, certificate, indorsement, rider, or	209
application that is filed under this section within three days of	210
the superintendent's receipt of the filing. The superintendent	211
shall organize the premium rates in the internet database by name	212
of insurer, type of policy, and filing date and shall clearly	213
label hyperlinks for each category. If the superintendent uses a	214
searchable database to post the premium rate filings, the	215
superintendent shall include search instructions and explanatory	216
material that is written in plain language and that is sufficient	217
to aid in easily finding a rate filing in the database.	218

The superintendent shall include a prominent hyperlink on the	219
homepage of the department's web site that connects to the	220
internet database created by the superintendent under this	221
section.	222

Section 2. That existing sections 1751.12 and 3923.02 of the	223
Revised Code are hereby repealed.	224