2006 Ohio Revised Code - 5111.13. Enrollment in group health plan.

§ 5111.13. Enrollment in group health plan.
 

(A)  As used in this section, "cost-effective" and "group health plan" have the same meanings as in section 1906 of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 1396e, as amended, and any regulations adopted under that section. 

(B)  The department of job and family services, pursuant to guidelines issued by the United States secretary of health and human services, shall identify cases in which enrollment of an individual otherwise eligible for medical assistance under this chapter in a group health plan in which the individual is eligible to enroll and payment of the individual's premiums, deductibles, coinsurance, and other cost-sharing expenses is cost effective. 
 

The department shall require, as a condition of eligibility for medical assistance, individuals identified under this division, or in the case of a child, the child's parent, to apply for enrollment in the group health plan, except that the failure of a parent to enroll self or the parent's child in a group health plan does not affect the child's eligibility under the medical assistance program. 
 

The department shall pay enrollee premiums and deductibles, coinsurance, and other cost-sharing obligations for services and items otherwise covered under the medical assistance program. The department shall treat coverage under the group health plan in the same manner as any other third-party liability under the program. If not all members of a family are eligible for medical assistance and enrollment of the eligible members in a group health plan is not possible without also enrolling the members who are ineligible for medical assistance, the department shall pay the premiums for the ineligible members if the payments are cost effective. The department shall not pay deductibles, coinsurance, or other cost-sharing obligations of enrolled members who are not eligible for medical assistance. 
 

The department may make payments under this section to employers, insurers, or other entities. The department may make the payments without entering into a contract with employers, insurers, or other entities. 

(C)  To the extent permitted by federal law and regulations, the department of job and family services shall coordinate the medical assistance program with group health plans in such a manner that the medical assistance program serves as a supplement to the group health plans. In its coordination efforts, the department shall consider cost-effectiveness and quality of care. The department may enter into agreements with group health plans as necessary to implement this division. 

(D)  The director of job and family services shall adopt rules in accordance with Chapter 119. of the Revised Code to implement this section. 
 

HISTORY: 144 v H 298 (Eff 7-26-91); 145 v H 152 (Eff 7-1-93); 148 v H 471. Eff 7-1-2000.
 

The effective date is set by section 12(A) of HB 471.