Ohio § 1751.02

§ 1751.02.

(A) Notwithstanding any law in this state to the contrary, any corporation, as defined

in section 1751.01 of the Revised Code , may apply to the superintendent of insurance for a certificate of authority to establish

and operate a health insuring corporation.  If the corporation applying for a certificate of authority is a foreign corporation

domiciled in a state without laws similar to those of this chapter, the corporation

must form a domestic corporation to apply for, obtain, and maintain a certificate

of authority under this chapter. (B) No person shall establish, operate, or perform the services of a health insuring

corporation in this state without obtaining a certificate of authority under this

chapter. (C) Except as provided by division (D) of this section, no political subdivision or department,

office, or institution of this state, or corporation formed by or on behalf of any

political subdivision or department, office, or institution of this state, shall establish,

operate, or perform the services of a health insuring corporation.  Nothing in this section shall be construed to preclude a board of county commissioners,

a county board of developmental disabilities, an alcohol and drug addiction services

board, a board of alcohol, drug addiction, and mental health services, or a community

mental health board, or a public entity formed by or on behalf of any of these boards,

from using managed care techniques in carrying out the board's or public entity's

duties pursuant to the requirements of Chapters 307., 329., 340., and 5126. of the

Revised Code.  However, no such board or public entity may operate so as to compete in the private

sector with health insuring corporations holding certificates of authority under this

chapter. (D) A corporation formed by or on behalf of a publicly owned, operated, or funded hospital

or health care facility may apply to the superintendent for a certificate of authority

under division (A) of this section to establish and operate a health insuring corporation. (E) A health insuring corporation shall operate in this state in compliance with this

chapter and Chapter 1753. of the Revised Code and shall operate in conformity with

its filings with the superintendent under this chapter, including filings made pursuant

to sections 1751.03 , 1751.11 , 1751.12 , and 1751.31 of the Revised Code . (F) An insurer licensed under Title XXXIX of the Revised Code need not obtain a certificate

of authority as a health insuring corporation to offer an open panel plan as long

as the providers and health care facilities participating in the open panel plan receive

their compensation directly from the insurer.  If the providers and health care facilities participating in the open panel plan

receive their compensation from any person other than the insurer, or if the insurer

offers a closed panel plan, the insurer must obtain a certificate of authority as

a health insuring corporation. (G) An intermediary organization need not obtain a certificate of authority as a health

insuring corporation, regardless of the method of reimbursement to the intermediary

organization, as long as a health insuring corporation or a self-insured employer

maintains the ultimate responsibility to assure delivery of all health care services

required by the contract between the health insuring corporation and the subscriber

and the laws of this state or between the self-insured employer and its employees. Nothing in this section shall be construed to require any health care facility, provider,

health delivery network, or intermediary organization that contracts with a health

insuring corporation or self-insured employer, regardless of the method of reimbursement

to the health care facility, provider, health delivery network, or intermediary organization,

to obtain a certificate of authority as a health insuring corporation under this chapter,

unless otherwise provided, in the case of contracts with a self-insured employer,

by operation of the “Employee Retirement Income Security Act of 1974,” 88 Stat. 829, 29 U.S.C.A. 1001 , as amended. (H) Any health delivery network doing business in this state, including any health delivery

network that is functioning as an intermediary organization doing business in this

state, that is not required to obtain a certificate of authority under this chapter

shall certify to the superintendent annually, not later than the first day of July,

and shall provide a statement signed by the highest ranking official which includes

the following information: (1) The health delivery network's full name and the address of its principal place of

business; (2) A statement that the health delivery network is not required to obtain a certificate

of authority under this chapter to conduct its business. (I) The superintendent shall not issue a certificate of authority to a health insuring

corporation that is a provider sponsored organization unless all health care plans

to be offered by the health insuring corporation provide basic health care services.  Substantially all of the physicians and hospitals with ownership or control of the

provider sponsored organization, as defined in section 1751.01 of the Revised Code , shall also be participating providers for the provision of basic health care services

for health care plans offered by the provider sponsored organization.  If a health insuring corporation that is a provider sponsored organization offers

health care plans that do not provide basic health care services, the health insuring

corporation shall be deemed, for purposes of section 1751.35 of the Revised Code , to have failed to substantially comply with this chapter. Except as specifically provided in this division and in division (A) of section 1751.28 of the Revised Code , the provisions of this chapter shall apply to all health insuring corporations that

are provider sponsored organizations in the same manner that these provisions apply

to all health insuring corporations that are not provider sponsored organizations. (J) Nothing in this section shall be construed to apply to any multiple employer welfare

arrangement operating pursuant to Chapter 1739. of the Revised Code. (K) Any person who violates division (B) of this section, and any health delivery network

that fails to comply with division (H) of this section, is subject to the penalties

set forth in section 1751.45 of the Revised Code .