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, health insuring corporations are required to inform enrollees about the scope of emergency service coverage and clarify that enrollees are not required to self-diagnose.

The new sections explicitly prohibit health insuring corporations and sickness and accident insurers from denying claims based solely on diagnosis codes, appointment duration, or the absence of an emergency medical condition if a prudent layperson would have reasonably expected one. The bill also reinforces the prompt payment requirements for insurers, ensuring that enrollees receive timely reimbursement for emergency services. Existing sections 1753.28 and 3923.65 are repealed to accommodate these changes.

Statutes affected:
As Introduced: 1753.28, 3923.65