Ohio § 1731.01

§ 1731.01.

As used in this chapter: (A) “ Alliance ” or “ small employer health care alliance ” means an existing or newly created organization that has been granted a certificate

of authority by the superintendent of insurance under section 1731.021 of the Revised Code and that is either of the following: (1) A chamber of commerce, trade association, professional organization, or any other

organization that has all of the following characteristics: (a) Is a nonprofit corporation or association; (b) Has members that include or are exclusively small employers; (c) Sponsors or is part of a program to assist such small employer members to obtain

coverage for their employees under one or more health benefit plans; (d) Except as provided in division (A)(1)(e) of this section, is not directly or indirectly

controlled, through voting membership, representation on its governing board, or otherwise,

by any insurance company, person, firm, or corporation that sells insurance, any provider,

or by persons who are officers, trustees, or directors of such enterprises, or by

any combination of such enterprises or persons. (e) Division (A)(1)(d) of this section does not apply to an organization that is comprised

of members who are either insurance agents or providers, that is controlled by the

organization's members or by the organization itself, and that elects to offer health

insurance exclusively to any or all of the following: (i) Employees and retirees of the organization; (ii) Insurance agents and providers that are members of the organization; (iii) Employees and retirees of the agents or providers specified in division (A)(1)(e)(ii)

of this section; (iv) Families and dependents of the employees, providers, agents, and retirees specified

in divisions (A)(1)(e)(i), (A)(1)(e)(ii), and (A)(1)(e)(iii) of this section. (2) A nonprofit corporation controlled by one or more organizations described in division

(A)(1) of this section. (B) “ Alliance program ” or “ alliance health care program ” means a program sponsored by a small employer health care alliance that assists

small employer members of such small employer health care alliance or any other small

employer health care alliance to obtain coverage for their employees under one or

more health benefit plans, and that includes at least one agreement between a small

employer health care alliance and an insurer that contains the insurer's agreement

to offer and sell one or more health benefit plans to such small employers and contains

all of the other features required under section 1731.04 of the Revised Code . (C) “ Eligible employees, retirees, their dependents, and members of their families ,” as used together or separately, means the active employees of a small employer,

or retired former employees of a small employer or predecessor firm or organization,

their dependents or members of their families, who are eligible for coverage under

the terms of the applicable alliance program. (D) “ Enrolled small employer ” or “ enrolled employer ” means a small employer that has obtained coverage for its eligible employees from

an insurer under an alliance program. (E) “ Health benefit plan ” means any hospital or medical expense policy of insurance or a health care plan

provided by an insurer, including a health insuring corporation plan, provided by

or through an insurer, or any combination thereof. “Health benefit plan” does not include any of the following: (1) A policy covering only accident, credit, dental, disability income, long-term care,

hospital indemnity, medicare supplement, specified disease, or vision care, except

where any of the foregoing is offered as an addition, indorsement, or rider to a health

benefit plan; (2) Coverage issued as a supplement to liability insurance, insurance arising out of

a workers' compensation or similar law, automobile medical-payment insurance, or insurance

under which benefits are payable with or without regard to fault and which is statutorily

required to be contained in any liability insurance policy or equivalent self-insurance; (3) Coverage issued by a health insuring corporation authorized to offer supplemental

health care services only. (F) “ Insurer ” means an insurance company authorized to do the business of sickness and accident

insurance in this state or, for the purposes of this chapter, a health insuring corporation

authorized to issue health care plans in this state. (G) “ Participants ” or “ beneficiaries ” means those eligible employees, retirees, their dependents, and members of their

families who are covered by health benefit plans provided by an insurer to enrolled

small employers under an alliance program. (H) “ Provider ” means a hospital, urgent care facility, nursing home, physician, podiatrist, dentist,

pharmacist, chiropractor, certified registered nurse anesthetist, dietitian, or other

health care provider licensed by this state, or group of such health care providers. (I) “ Qualified alliance program ” means an alliance program under which health care benefits are provided to one thousand

or more participants. (J) “ Small employer ,” regardless of its definition in any other chapter of the Revised Code, in this

chapter means an employer that employs no more than five hundred full-time employees,

at least a majority of whom are employed at locations within this state. (1) For this purpose: (a) Each entity that is controlled by, controls, or is under common control with, one

or more other entities shall, together with such other entities, be considered to

be a single employer. (b) “ Full-time employee ” means a person who normally works at least twenty-five hours per week and at least

forty weeks per year for the employer. (c) An employer will be treated as having five hundred or fewer full-time employees on

any day if, during the prior calendar year or any twelve consecutive months during

the twenty-four full months immediately preceding that day, the mean number of full-time

employees employed by the employer does not exceed five hundred. (2) An employer that qualifies as a small employer for purposes of becoming an enrolled

small employer continues to be treated as a small employer for purposes of this chapter

until such time as it fails to meet the conditions described in division (J)(1) of

this section for any period of thirty-six consecutive months after first becoming

an enrolled small employer, unless earlier disqualified under the terms of the alliance

program.