The bill amends sections 1753.28 and 3923.65 of the Revised Code and enacts new sections 1753.29 and 3923.66, aimed at protecting enrollees of health insuring corporations and sickness and accident insurers from claim reductions or denials based on specific criteria. Key provisions include the definition of "emergency medical condition," which now encompasses both physical and mental health conditions, and mandates that emergency services must be covered without regard to prior authorization or the time of service. Additionally, the bill stipulates that insurers cannot deny claims based solely on diagnosis codes, appointment duration, or the absence of an emergency medical condition if a prudent layperson would have expected one.

Furthermore, the bill emphasizes the importance of informing enrollees about their coverage for emergency services, including the fact that they are not required to self-diagnose. It also establishes that insurers must adhere to prompt payment requirements, ensuring that enrollees receive timely reimbursement for emergency services. The existing sections 1753.28 and 3923.65 are repealed to accommodate these changes, reflecting a significant shift towards more consumer-friendly practices in health insurance claims processing.

Statutes affected:
As Introduced: 1753.28, 3923.65