2006 Ohio Revised Code - 3924.10. Design, adoption and contents of OHC plans; renewal of coverage.

§ 3924.10. Design, adoption and contents of OHC plans; renewal of coverage.
 

(A)  The board of directors of the Ohio health reinsurance program shall design the OHC basic, standard, and carrier reimbursement plans which, when offered by a carrier, are eligible for reinsurance under the program. The board shall establish the form and level of coverage to be made available by carriers in their OHC plans. In designing the plans the board shall also establish benefit levels, deductibles, coinsurance factors, exclusions, and limitations for the plans. The forms and levels of coverage established by the board shall specify which components of health benefit plans offered by a carrier may be reinsured. The OHC plans are subject to division (C) of section 3924.02 of the Revised Code and to the provisions in Chapters 1751., 1753., 3923., and any other chapter of the Revised Code that require coverage or the offer of coverage of a health care service or benefit. 

(B)  The board shall adopt the OHC plans within one hundred eighty days after the effective date of this amendment. The plans may include cost containment features including any of the following: 

(1) Utilization review of health care services, including review of the medical necessity of hospital and physician services; 

(2) Case management benefit alternatives; 

(3) Selective contracting with hospitals, physicians, and other health care providers; 

(4) Reasonable benefit differentials applicable to participating and nonparticipating providers; 

(5) Employee assistance program options that provide preventive and early intervention mental health and substance abuse services; 

(6) Other provisions for the cost-effective management of the plans. 

(C)  OHC plans established for use by health insuring corporations shall be consistent with the basic method of operation of such corporations. 

(D)  Each carrier shall certify to the superintendent of insurance, in the form and manner prescribed by the superintendent, that the OHC plans filed by the carrier are in substantial compliance with the provisions of the board OHC plans. Upon receipt by the superintendent of the certification, the carrier may use the certified plans. 

(E)  Each carrier shall, on and after sixty days after the date that the program becomes operational and as a condition of transacting business in this state, renew coverage provided to any individual or group under its OHC plans. 
 

HISTORY: 144 v H 478 (Eff 4-14-93); 147 v S 67 (Eff 6-4-97); 147 v H 374 (Eff 6-30-97); 147 v H 361 (Eff 10-1-98); 147 v H 698. Eff 3-22-99.