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Health Benefit Mandate Study

Health Benefit Mandate Study

39 Ohio Rev. Code § 3901.88 requires the superintendent of insurance to conduct an actuarial study on the costs of all health care mandates under state law that apply to individual and group insurance plans not subject to the “Employee Retirement Income Security act of 1974,” 29 U.S.C. 1001, et seq. BerryDunn was engaged to prepare this actuarial analysis. 

As an initial step, BerryDunn reviewed Ohio statutes and conferred with ODI to develop a list of mandates to be included in the study. Statutory citations for mandated health benefits in Ohio are located in Chapter 1751 (Health Insuring Corporation Law) and Chapter 3923 (Sickness and Accident Insurance). 

Based on BerryDunn’s research and discussions with ODI, the following list of mandated benefits was prepared, with each specific citation noted.  Comments on the proposed list are welcome and can be submitted to HealthBenefitMandateSurvey@insurance.ohio.gov

​Kidney dialysis benefits Coverage of outpatient dialysis on an equal basis as inpatient ​39 Ohio Rev. Code § 3923.25
​Maternity benefits ​Coverage of minimum maternity stay ​39 Ohio Rev. Code § 3923.63
17 Ohio Rev. Code § 1751.67
​39 Ohio Rev. Code § 3923.64
Cancer medication; coverage for orally and intravenously administered treatments ​Parity of oral/intravenous chemotherapy 39 Ohio Rev. Code § 3923.85
17 Ohio Rev. Code § 1751.69
​Screening mammography and cytologic screening benefits ​Coverage of screening mammography and cytologic screening ​39 Ohio Rev. Code § 3923.52
39 Ohio Rev. Code § 3923.53
39 Ohio Rev. Code § 3923.54
17 Ohio Rev. Code § 1751.62
​Denial of coverage to cancer clinical trial participant/Basic health services ​Coverage of routine patient care administered to insured member participating in cancer trial ​39 Ohio Rev. Code § 3923.80
17 Ohio Rev. Code § 1751.01
Basic health services ​Coverage of infertility services ​17 Ohio Rev. Code § 1751.01
​Coverage for autism ​Coverage of screening, diagnosis, and treatment of autism spectrum disorder/Prohibits termination of/refusal to renew based on diagnosis ​17 Ohio Rev. Code § 1751.84
​39 Ohio Rev. Code § 3923.84
Outpatient, inpatient, and intermediate primary care benefits for alcoholism Coverage of outpatient, inpatient, and intermediate primary care benefits for alcoholism 39 Ohio Rev. Code § 3923.29
39 Ohio Rev. Code § 3923.30
​Outpatient coverage for mental or emotional disorders ​Coverage of outpatient services for mental or emotional disorders/Coverage limits and treatment plan requirements ​39 Ohio Rev. Code § 3923.28
Biologically based mental illness ​Parity of biological-based mental illness/physical health benefits 39 Ohio Rev. Code § 3923.281
39 Ohio Rev. Code § 3923.282
​Coverage for emergency services Coverage of emergency services without prior authorization and regardless of day or time ​39 Ohio Rev. Code § 3923.65
17 Ohio Rev. Code § 1751.28
Benefits for child health supervision services from moment of birth until age nine ​Coverage of health supervision and hearing screening ​39 Ohio Rev. Code § 3923.55
39 Ohio Rev. Code § 3923.56
​Coverage for newly born ​Coverage from moment of birth ​17 Ohio Rev. Code § 1751.61
​39 Ohio Rev. Code § 3923.26
​Prescription drugs (HIC)/Standard medical reference compendia for coverage of prescription drugs ​Coverage of off-label drugs ​​17 Ohio Rev. Code § 1751.66
​39 Ohio Rev. Code § 3923.60
39 Ohio Rev. Code § 3923.61
​Coverage for alcohol or drug-related losses or expenses ​Prohibits exclusion of coverage for a loss or expense the insured sustains as a result of the insured's use of alcohol or other drugs or both when the loss or expense is otherwise covered under the plan ​39 Ohio Rev. Code § 3923.82
​Continuing coverage for dependent children ​Coverage of unmarried child until twenty-six years of age and ongoing coverage of a child incapable of sustaining employment ​39 Ohio Rev. Code § 3923.24
39 Ohio Rev. Code § 3923.241
17 Ohio Rev. Code § 1751.14