Read the full stored bill text
As Introduced
136th
General Assembly
Regular
Session
H. B. No. 390
2025-2026
Representative Schmidt
To
enact section 3902.55 of the Revised Code
to
prohibit health plan issuers from requiring or inducing providers to
collect copayments and other cost sharing amounts.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
section 3902.55 of the Revised Code be enacted to read as follows:
Sec.
3902.55.
(A)
As used in this section:
(1)
"Benefits contract" means an agreement by a health plan
issuer to reimburse a provider for covered health care services
rendered to a covered person up to the limits and exclusions
contained in the benefits contract or the covered persons' health
benefit plan.
(2)
"Health care service" has the same meaning as in section
4743.10 of the Revised Code;
(3)
"Provider" means a hospital, nursing home, physician,
podiatrist, dentist, pharmacist, chiropractor, or other health care
provider entitled to reimbursement by a health plan issuer for
services rendered to a covered person under a benefits contract.
(4)
"Reimburse" means indemnify, make payment, or otherwise
accept responsibility for payment for health care services rendered
to a covered person, or arrange for the provision of health care
services to a covered person.
(B)
On and after January 1, 2027, no health plan issuer shall require or
otherwise induce a provider to collect cost sharing amounts for
health care services, including copayments and deductibles, from
covered persons.
(C)
On and after January 1, 2027, a health plan issuer shall make all
reimbursement for covered services directly to the health care
provider.
(D)
Divisions (B) and (C) of this section do not apply to the extent
those divisions conflict with a benefits contract or health benefit
plan entered into before January 1, 2027, unless the contract or plan
is amended or renewed after that date, in which case the health plan
issuer shall ensure that the contract or plan meets the requirements
of this section.
(E)
A health benefit plan or benefits contract entered into, amended, or
renewed on or after January 1, 2027, shall not require either of the
following:
(1)
Health care providers to collect cost sharing amounts from covered
persons;
(2)
Covered persons to pay cost sharing amounts to a health care
provider.
(F)
This section shall not be construed to prohibit a health care
provider from doing either of the following:
(1)
Collecting amounts owed for uncovered services;
(2)
Accepting a cash payment from a covered person in lieu of accepting
reimbursement under a health benefit plan.