To amend sections 3901.22 and 3922.07 and to enact sections 3901.216, 3901.97, and 3922.171 of the Revised Code to establish a medical claims consumer assistance program, to prohibit health insurers from improperly denying health claims, and to name this act the Fair Health Claims Act.
HB891, the Fair Health Claims Act, would create new consumer protections and oversight requirements for Ohio health insurance claims handling. The bill prohibits a health plan issuer from wrongfully denying, reducing, or terminating a covered health care service or payment, and it authorizes the superintendent of insurance to enforce that prohibition through existing insurance-law procedures, including cease-and-desist orders, administrative remedies, and court actions. In those enforcement actions, the bill allows double damages to affected consumers, reimbursement of expert and legal expenses, and civil penalties, with penalty amounts adjusted over time for inflation or premium growth.
The bill also establishes a medical claims consumer assistance program within the Department of Insurance. That program would help consumers understand and use internal appeals and external review processes, resolve disputed claims, file complaints, obtain enrollment assistance, and access premium tax credit information. Health plan issuers would be required to place a prominent notice about the program on plan communications, and the superintendent could contract with a nonprofit to administer the program, so long as it is not affiliated with a health insurer.
In addition to consumer assistance and enforcement, HB891 expands reporting and transparency obligations. Health plan issuers would have to submit data on adverse benefit determinations, and the superintendent would publish annual reports on claim denials, wrongful determinations, consumer complaints, and enforcement outcomes. The bill also directs independent review organizations to consider whether there is evidence that a health plan issuer intended to improperly deny or reduce a claim when reviewing adverse benefit determinations.
The bill would affect Ohio insurance law by adding new sections to the Revised Code and amending existing sections governing unfair insurance practices and external review. It would increase the regulatory and financial exposure of health insurers and could lead to more state enforcement actions, more consumer appeals support, and more public reporting on claim denial patterns. It also creates a mechanism for identifying insurers with denial rates above the statewide median and requiring further review.
Overall sentiment appears supportive of stronger consumer protections, but the bill is still at the introduction stage and there is no recorded committee debate or vote history in the provided materials. The main likely point of contention is the scope of enforcement and penalties, especially the double-damages remedy, expanded civil penalties, and the requirement that insurers fund or comply with more reporting and notice obligations. Insurers may view the bill as increasing litigation risk and administrative burden, while consumer advocates would likely favor its emphasis on accountability and assistance for patients.
HB891 would add new statutory duties for the Ohio Department of Insurance and health plan issuers, including a consumer assistance program, enhanced claim-denial oversight, mandatory issuer reporting, and new enforcement tools for wrongful adverse benefit determinations. It would amend existing insurance code provisions and create new Revised Code sections that expand remedies against insurers and require public reporting on denial patterns and complaint outcomes.
There is no recorded vote or committee testimony in the provided materials, so formal legislative sentiment cannot be measured from debate history. Based on the bill’s structure, the measure is oriented toward consumer protection and insurer accountability, suggesting likely support from patient and consumer advocates and likely concern from health insurers and industry stakeholders over expanded penalties, reporting, and enforcement exposure.
The most notable points of contention are likely the bill’s strong remedies for wrongful claim denials, including double damages, civil penalties, and possible repeated-violation penalties, as well as the requirement that insurers provide prominent notices and submit detailed claims data. Another likely issue is the expanded role of the superintendent and attorney general in enforcement, which could be viewed as increasing regulatory intervention. Health insurers may argue the bill could raise costs and encourage litigation, while supporters would emphasize improved access to covered care and better consumer recourse.