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As Introduced
136th
General Assembly
Regular
Session
H. B. No. 24
2025-2026
Representatives Callender, Sweeney
Cosponsors: Representatives Williams,
Rader, Russo, Synenberg, Piccolantonio, Brennan, Troy, Sigrist,
Brewer, Grim, Lett, Baker, Cockley, Hall, D.
A
BILL
To
amend sections 3923.33, 3923.331, 3923.332, 3923.337, 3923.338,
3923.339, and 3923.42 and to enact section 3923.3310 of the Revised
Code
to provide Medigap policies for Medicare-eligible individuals under
the age of 65.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 3923.33, 3923.331, 3923.332, 3923.337, 3923.338, 3923.339,
and 3923.42 be amended and section 3923.3310 of the Revised Code be
enacted to read as follows:
Sec.
3923.33.
As
used in section 3923.33 and sections 3923.331 to
3923.339
3923.3310
of
the Revised Code:
(A)
"Applicant" means:
(1)
In the case of an individual medicare supplement policy, the person
who seeks to contract for insurance benefits; and
(2)
In the case of a group medicare supplement policy, the proposed
certificate holder.
(B)
"Certificate" means, for purposes of section 3923.33 and
sections 3923.331 to
3923.339
3923.3310
of
the Revised Code, any certificate delivered or issued for delivery in
this state under a group medicare supplement policy.
(C)
"Certificate form" means the form on which the certificate
is delivered or issued for delivery by the issuer.
(D)
"Direct response insurance policy" means a medicare
supplement policy or certificate marketed without the direct
involvement of an insurance agent.
(E)
"Issuer" includes insurance companies, fraternal benefit
societies, health insuring corporations, and any other entities
delivering or issuing for delivery in this state medicare supplement
policies or certificates.
(F)
"Medicare" means the "Health Insurance for the Aged
Act," Title XVIII of the Social Security Amendments of 1965, 79
Stat. 291, 42 U.S.C.A. 1395, as then constituted or later amended.
(G)
"Medicare supplement policy" means a group or individual
policy of sickness and accident insurance or a subscriber contract of
health insuring corporations or any other issuers, other than a
policy issued pursuant to a contract under section 1876 of the
"Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A.,
1395mm, as amended, or an issued policy under any demonstration
project specified in 42 U.S.C.A. 1395ss(g)(1), which is advertised,
marketed, or designed primarily as a supplement to reimbursements
under medicare for the hospital, medical, or surgical expenses of
persons eligible for medicare.
(H)
"Policy form" means the form on which the policy is
delivered or issued for delivery by the issuer.
Sec.
3923.331.
(A)
Except as otherwise provided in the Revised Code, section 3923.33 and
sections 3923.331 to
3923.339
3923.3310
of
the Revised Code shall apply to:
(1)
All medicare supplement policies delivered or issued for delivery in
this state on or after the effective date of this amendment; and
(2)
All certificates issued under group medicare supplement policies,
which certificates are delivered or issued for delivery in this state
on or after the effective date of this amendment.
(B)
Section 3923.33 and sections 3923.331 to
3923.339
3923.3310
of
the Revised Code shall not apply to a policy of one or more employers
or labor organizations, or of the trustees of a fund established by
one or more employers or labor organizations, or a combination
thereof, for employees or former employees, or a combination thereof,
or for members or former members, or a combination thereof, of the
labor organizations.
(C)
Except as otherwise provided in division (D) of section 3923.334 of
the Revised Code, section 3923.33 and sections 3923.331 to
3923.339
3923.3310
of
the Revised Code are not intended to prohibit or apply to insurance
policies or health care benefit plans, including group conversion
policies, provided to medicare eligible persons, which policies are
not marketed or held to be medicare supplement policies or benefit
plans.
Sec.
3923.332.
(A)
No medicare supplement policy or certificate in force in this state
shall contain benefits that duplicate benefits provided by medicare.
(B)
Notwithstanding section 3923.04 of the Revised Code or any other
provision of law of this state, a medicare supplement policy or
certificate shall not exclude or limit benefits for losses incurred
more than six months from the effective date of coverage because it
involved a preexisting condition. The policy or certificate shall not
define a preexisting condition more restrictively than a condition
for which medical advice was given or treatment was recommended by or
received from a physician within six months before the effective date
of coverage.
(C)
The superintendent of insurance shall adopt reasonable rules to
establish specific standards for policy provisions of medicare
supplement policies and certificates. The standards shall be in
addition to and in accordance with applicable laws of this state,
including sections 3923.03 to 3923.09 of the Revised Code. No
requirement in Title XVII or XXXIX of the Revised Code relating to
minimum required policy benefits, other than the minimum standards
contained in section 3923.33 and sections 3923.331 to
3923.339
3923.3310
of
the Revised Code, shall apply to medicare supplement policies and
certificates. The standards may cover, but are not limited to:
(1)
Terms of renewability;
(2)
Initial and subsequent conditions of eligibility;
(3)
Nonduplication of coverage;
(4)
Probationary periods;
(5)
Benefit limitations, exceptions, and reductions;
(6)
Elimination periods;
(7)
Requirements for replacement;
(8)
Recurrent conditions; and
(9)
Definitions of terms.
(D)
The superintendent shall adopt reasonable rules to establish minimum
standards for benefits, claims payment, advertising and marketing
practices and compensation arrangements, and reporting practices, for
medicare supplement policies and certificates.
(E)
The superintendent may adopt from time to time such reasonable rules
as are necessary to conform medicare supplement policies and
certificates to the requirements of federal law and regulations
promulgated thereunder, including but not limited to:
(1)
Requiring refunds or credits if the policies or certificates do not
meet loss ratio requirements;
(2)
Establishing a uniform methodology for calculating and reporting loss
ratios;
(3)
Assuring public access to policies, premiums, and loss ratio
information of issuers of medicare supplement insurance;
(4)
Establishing a process for approving or disapproving policy forms and
certificate forms and proposed premium increases;
(5)
Establishing a policy for holding public hearings prior to approval
of premium increases; and
(6)
Establishing standards for medicare select policies and certificates.
(F)
The superintendent may adopt reasonable rules that specify prohibited
policy provisions not otherwise specifically authorized by any
provision in the Revised Code that, in the opinion of the
superintendent, are unjust, unfair, or unfairly discriminatory to any
person insured or proposed to be insured under a medicare supplement
policy or certificate.
Sec.
3923.337.
All
rules adopted pursuant to section 3923.33 and sections 3923.331 to
3923.339
3923.3310
of
the Revised Code shall be subject to Chapter 119. of the Revised
Code.
Sec.
3923.338.
In
addition to any other applicable penalties for violations of Title
XVII or XXXIX of the Revised Code, the superintendent of insurance,
pursuant to an adjudication conducted in accordance with Chapter 119.
of the Revised Code, may issue an order requiring issuers violating
any provision of section 3923.33 or sections 3923.331 to
3923.339
3923.3310
of
the Revised Code or rules adopted pursuant to those sections to do
either or both of the following:
(A)
Cease marketing any medicare supplement policy or certificate in this
state that is related directly or indirectly to the violation;
(B)
Take such actions as are necessary to comply with section 3923.33 and
sections 3923.331 to
3923.339
3923.3310
of
the Revised Code.
Sec.
3923.339.
If
any provision of section 3923.33 or sections 3923.331 to
3923.339
3923.3310
of
the Revised Code or the application thereof to any person or
circumstances is for any reason held to be invalid, the remainder of
section 3923.33 and sections 3923.331 to
3923.339
3923.3310
of
the Revised Code and the application of such remainder to other
persons or circumstances shall not be affected thereby.
Sec.
3923.3310.
(A)
Not later than the first day of January that immediately follows the
effective date of this section, any issuer that offers coverage under
a medicare supplement policy to individuals sixty-five years of age
or older shall offer the same coverage to individuals younger than
sixty-five years of age who are eligible for and enrolled in medicare
by reason of disability or end stage renal disease.
(B)
Any benefit, protection, policy, or procedure applicable to coverage
under a policy for an individual sixty-five years or older shall also
apply to coverage offered under this section.
(C)
The premiums for coverage offered under this section to individuals
who are sixty-four years of age or younger shall not be higher than
the premiums for a medicare supplement policy offered to individuals
sixty-five years of age.
(D)(1)
Except as otherwise provided in division (D)(2) of this section, an
issuer shall comply with sections 3923.33 to 3933.3310 of the Revised
Code when issuing policies under this section.
(2)
Notwithstanding any provision of the Revised Code to the contrary, a
policy issued under this section shall not exclude or limit benefits
for losses attributable to a preexisting condition.
(E)
An issuer shall offer to individuals younger than sixty-five years of
age who are eligible for and enrolled in medicare by reason of
disability or end stage renal disease an open enrollment period for
coverage offered under this section that begins on the first day of
January that immediately follows the effective date of this section
and ends on the immediately following first day of July.
(F)
Each year, a person who is already covered under a policy issued
under this section may, within sixty days of the person's date of
birth, acquire a new medicare supplement policy offering the same
coverage as the person's existing policy from a different issuer.
Sec.
3923.42.
(A)
Sections 3923.41 to 3923.48 of the Revised Code may be cited as the
"long-term care insurance act."
(B)
Sections 3923.41 to 3923.48 of the Revised Code do not supersede the
obligations of entities subject to these sections to comply with the
substance of other applicable insurance laws insofar as they do not
conflict with these sections, except that section 3923.33 and
sections 3923.331 to
3923.339
3923.3310
of
the Revised Code and rules intended to apply to medicare supplement
insurance policies do not apply to long-term care insurance. A policy
that is not advertised, marketed, or offered as long-term care
insurance need not meet the requirements of sections 3923.41 to
3923.48 of the Revised Code.
Section
2.
That
existing sections 3923.33, 3923.331, 3923.332, 3923.337, 3923.338,
3923.339, and 3923.42 of the Revised Code are hereby repealed.