H.B. No. 536 Summary

• Prohibits health plan issuers from implementing selective emergency services coverage, defined as making coverage for emergency services dependent on determining whether an injury, symptom, or complaint was truly an emergency

• Applies to all health benefit plans including those participating in the Medicaid care management system

• Establishes violation of this prohibition as an unfair or deceptive practice under Ohio insurance law

• Requires Medicaid managed care organizations to comply with the prohibition through contract requirements with the Department of Medicaid

• Applies to health benefit plans issued or contracts entered into, modified, or renewed on or after the effective date of the act