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Synopsis of Committee Amendments
Legislative Service Commission
Sub. S.B. 43
125th General Assembly
Requires health insuring corporations (HICs),
sickness and accident insurers, multiple employer welfare arrangements (MEWAs),
and public employee benefit plans to comply with the bill's requirements. (The As Passed by the Senate version requires HICs, sickness and accident insurers, pharmacy benefit managers, and health benefits plans established by the state of Ohio to comply with the bill's requirements.)
Provides that the bill's requirements apply to the following
in addition to
HIC policies, contracts, and agreements and policies of sickness and accident insurance delivered, issued for delivery, renewed, or used in Ohio:
MEWAs authorized to enter into arrangements in Ohio on or after the effective date of the bill.
Public employee benefit plans
established or modified by Ohio on or after the effective date of the bill. (The As Passed by the Senate version refers to
benefit plans, other than Medicaid, established or modified in Ohio
on or after the bill's effective date.)
Specifies that coverage provided under an employer's self-insurance plan or by any of the plan's administrators, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of the bill to the plan and its administrators, is exempted from the bill's requirements.
Requires a standardized identification card or electronic technology issued by an insurer to contain only certain uniform prescription information. (The As Passed by the Senate version requires a card or technology to contain uniform prescription
Specifies that if a standardized identification card or electronic technology is also used for submission and routing of nonpharmacy claims, the designation "Rx"
required to be included as part of the labels on the card or in the technology
if the issuer's international identification card number or the processor's control number is different for medical and pharmacy claims.
Specifies that, with respect to the information a HIC or person under contract with a HIC to issue standardized identification cards or electronic technology is required to place on a card or in a technology, the card or technology must include information on the
rather than the
Refers to a contractor to which an insurer outsources the issuance of a standardized identification card or electronic technology as a person under contract with the insurer
to issue a standardized identification card or an electronic technology,
rather than a person under contract with the insurer
to provide managerial or administrative services.
Requires each HIC, MEWA, and sickness and accident insurer to annually file a certificate with the Superintendent of Insurance certifying that it, or any person it contracts with to issue standardized identification cards or electronic technology for submission and routing of prescription drug claims, complies with the bill's requirements.
Amends the definition of "group life insurance" to mean that form of life insurance covering not less than two employees (rather than 10 employees as in current law).
Under existing law, a health insuring corporation (HIC) is an entity, such as a health maintenance organization (HMO), that provides health care coverage through participating health care providers. See R.C. 1751.01(N).
Ohio law defines MEWA (multiple employer welfare arrangement) as an employee welfare benefit plan, trust, or any other arrangement, whether or not such plan, trust, or arrangement is subject to the federal Employee Retirement Income Security Act of 1974 (ERISA), that is established or maintained for the purpose of offering or providing, through group insurance or group self-insurance programs, medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, or death, to the employees, and their dependents, of two or more employers, or to two or more self-employed individuals and their dependents. (R.C. 1731.01(F).)
In general, this means employee benefit plans subject to the Employee Retirement Income Security Act of 1974 (1974).