The Fair Health Claims Act aims to strengthen consumer protections in the health insurance sector by establishing a medical claims consumer assistance program and prohibiting wrongful denial of health claims by insurers. The bill introduces new sections in the Revised Code, specifically sections 3901.216 and 3901.97, which outline the responsibilities of health plan issuers regarding the denial, reduction, or termination of health care services. Violations of these provisions could result in significant penalties, including double damages for consumers and civil penalties of up to $25,000 for each violation. Additionally, the superintendent of insurance is tasked with increasing penalty amounts annually based on health insurance premium rates or inflation.

The bill also mandates that independent review organizations consider evidence of intent to improperly deny health care services and requires the superintendent of insurance to maintain detailed records of adverse benefit determinations. An annual report detailing the total number and type of adverse determinations, including wrongful ones, must be submitted to key state officials and made publicly available. Furthermore, the bill emphasizes collaboration with state and local agencies for effective implementation and outreach. As part of this legislative update, existing sections 3901.22 and 3922.07 of the Revised Code are repealed.

Statutes affected:
As Introduced: 3901.22, 3922.07