Ohio § 1751.04

§ 1751.04.

(A) Except as provided by division (D) of this section, upon the receipt by the superintendent

of insurance of a complete application for a certificate of authority to establish

or operate a health insuring corporation, which application sets forth or is accompanied

by the information and documents required by division (A) of section 1751.03 of the Revised Code , the superintendent shall review the application and accompanying documents and make

findings as to whether the applicant for a certificate of authority has done all of

the following with respect to any basic health care services and supplemental health

care services to be furnished: (1) Demonstrated the willingness and potential ability to ensure that all basic health

care services and supplemental health care services described in the evidence of coverage

will be provided to all its enrollees as promptly as is appropriate and in a manner

that assures continuity; (2) Made effective arrangements to ensure that its enrollees have reliable access to

qualified providers in those specialties that are generally available in the geographic

area or areas to be served by the applicant and that are necessary to provide all

basic health care services and supplemental health care services described in the

evidence of coverage; (3) Made appropriate arrangements for the availability of short-term health care services

in emergencies within the geographic area or areas to be served by the applicant,

twenty-four hours per day, seven days per week, and for the provision of adequate

coverage whenever an out-of-area emergency arises; (4) Made appropriate arrangements for an ongoing evaluation and assurance of the quality

of health care services provided to enrollees, including, if applicable, the development

of a quality assurance program complying with the requirements of sections 1751.73 to 1751.75 of the Revised Code , and the adequacy of the personnel, facilities, and equipment by or through which

the services are rendered; (5) Developed a procedure to gather and report statistics relating to the cost and effectiveness

of its operations, the pattern of utilization of its services, and the quality, availability,

and accessibility of its services. (B) Based upon the information provided in the application for issuance of a certificate

of authority, the superintendent shall determine whether or not the applicant meets

the requirements of division (A) of this section.  If the superintendent determines that the applicant does not meet these requirements,

the superintendent shall specify in what respects it is deficient.  However, the superintendent shall not deny an application because the requirements

of this section are not met unless the applicant has been given an opportunity for

a hearing on that issue. (C) If the applicant requests a hearing, the superintendent shall hold a hearing before

denying an application because the applicant does not meet the requirements of this

section.  The hearing shall be held in accordance with Chapter 119. of the Revised Code. (D) Nothing in this section requires the superintendent to review or make findings with

regard to an application and accompanying documents to establish or operate any of

the following: (1) A health insuring corporation to cover solely medicaid recipients; (2) A health insuring corporation to cover solely medicare beneficiaries; (3) A health insuring corporation to cover solely medicaid recipients and medicare beneficiaries; (4) A health insuring corporation to cover solely federal employees and other individuals

eligible for coverage in the federal employees health benefits program pursuant to 5 U.S.C. 8905 .