To enact section 3901.93 of the Revised Code to establish network adequacy standards for health insurers.
HB219 would create a new section of the Ohio Revised Code establishing network adequacy standards for health insurers that use network plans. The bill requires health plan issuers to maintain provider networks that give covered persons reasonable access to needed care without unreasonable travel or delay, including sufficient numbers and types of providers, emergency services at all times, and access for children and adults. It directs the Superintendent of Insurance to set criteria for evaluating network adequacy, including provider-to-member ratios, geographic access, wait times, hours of operation, and the needs of low-income individuals, children, adults, people with chronic or complex conditions, people with disabilities, and people with limited English proficiency.
The bill also requires insurers to file network plans, premium rates, and access arrangements with the Department of Insurance before use in Ohio, and to notify the superintendent of material changes. It would require insurers to maintain processes that allow covered persons to receive out-of-network care at in-network cost-sharing levels when an adequate in-network provider is unavailable, especially for specialty care, and to count that care toward in-network out-of-pocket limits. Insurers would also have to publish provider directories, monitor provider capacity and legal authority, and maintain continuity-of-care procedures if provider contracts end or the insurer stops operating. The superintendent could adopt rules to administer and enforce the new section.
If enacted, HB219 would add a new regulatory framework to Ohio insurance law focused on access standards for health benefit plans. It would expand the Department of Insurance’s oversight of network design, directory accuracy, access arrangements, and consumer protections tied to out-of-network exceptions. The bill would affect health plan issuers, covered persons, providers, and the superintendent of insurance by imposing compliance, reporting, and documentation requirements.
The available legislative history shows the bill was introduced and referred to the House Insurance Committee, with no recorded votes or committee transcript excerpts provided. As a result, there is no documented public debate in the supplied materials, but the bill’s structure suggests a consumer-protection and access-to-care focus. The general sentiment inferred from the text is supportive of stronger network adequacy standards, particularly for patients who face barriers to in-network care.
The main points of potential contention are likely to involve the scope and cost of compliance for insurers, the level of discretion given to the superintendent, and the operational burden of maintaining and documenting adequate networks across different regions and specialties. Insurers may also object to requirements that treat certain out-of-network services as in-network for cost-sharing purposes, while patient advocates and providers serving underserved populations would likely support those protections. Another likely issue is how strictly travel distance, wait time, and provider availability standards should be set and enforced.
HB219 would create a new statutory section, R.C. 3901.93, governing health insurer network adequacy in Ohio. It would require network plans to meet minimum access standards, submit plans and access arrangements to the Department of Insurance, maintain provider directories, monitor network capacity, and provide in-network cost-sharing for certain out-of-network services when adequate in-network care is unavailable. The bill would expand the superintendent of insurance’s authority to set criteria, review filings, publish survey results, and enforce compliance, directly affecting health plan issuers, providers, and covered persons.
No committee testimony, debate transcript, or vote record was provided, so there is no direct evidence of support or opposition in the supplied materials. Based on the bill text, the measure appears aimed at improving consumer access to care and strengthening oversight of insurer networks, which suggests a generally pro-consumer policy direction. The absence of recorded opposition in the provided context means the overall sentiment cannot be measured from legislative action, only inferred from the bill’s purpose.
Likely areas of contention include the administrative and financial burden on insurers, the feasibility of meeting provider ratio, travel, and wait-time standards in rural or underserved areas, and the extent to which the superintendent should control network-adequacy criteria. Insurers may also resist the requirement to cover certain out-of-network services at in-network cost-sharing levels and to count those services toward in-network out-of-pocket limits. On the other hand, consumer advocates, patients with complex conditions, people with disabilities, and residents of medically underserved areas would likely favor the bill’s access and continuity-of-care protections.