Lawriter - OAC - 123-6-02 Definitions.

123-6-02 Definitions.

(A) "Board" means the school employees health care board of the state of Ohio.

(B) "Health plan sponsor" means a public school district, a consortium of public school districts, or a council of governments, which sponsors a health care plan.

(C) "Health care plan" includes group policies, contracts, and agreements entered into by a health plan sponsor that provide hospital, surgical, or medical expense coverage, including self-insured plans. A health care plan does not include a plan offered to individual employees of a public school district or a plan that provides coverage only for specific disease or accidents, or a hospital indemnity, Medicare supplement, or other plan that provides only supplemental benefits, paid for by the employees of a public school district.

(D) "Public school district" means a city, local, exempted village, or joint vocational school district, and includes the educational service centers associated with those districts. Charter schools are not included in this definition.

(E) "Best practice standards" means procedures, programs, activities or actions that the Board has determined to demonstrate effectiveness in assuring the provision of quality health care and improving the health status of a particular population. The goals of best practices are to derive the greatest value in purchasing health insurance and health care and improve the health of public school district employees and their families.

(F) "Wellness or healthy lifestyle program" means a program that consists of a combination of activities designed to increase awareness, assess risks, educate, and promote voluntary behavior change to improve the health of an individual, encourage modifications of his or her health status, and enhance his or her personal well-being and productivity, with a goal of preventing illness and injury.

(G) "Disease management" means a program that includes both education and support activities designed to increase individuals' awareness and understanding of their disease(s), promote voluntary behavior change, improve self-care, with the goal of preventing or managing complications associated with targeted chronic diseases.

(H) "Clinically superior healthcare" means a medically necessary procedure, process, activity or treatment plan that has demonstrated greater effectiveness than competing procedures or treatment plans in producing positive clinical outcomes and financial results.

(I) "Health information" means personally identifiable information collected through a wellness or healthy lifestyle program, including demographic information, and relates to the past, present or anticipated future medical condition of an individual.

(J) "Dependent eligibility audit" means a process which reviews the eligibility requirements of a health care plan and verifies the eligibility of all dependents currently receiving benefits under the health care plan.

(K) "Maintenance drugs" means medications prescribed for chronic, long-term conditions that are taken on a regular, recurring basis, including but not limited to medicine for: high blood pressure, high cholesterol, and diabetes.

(L) "Joint purchasing arrangement" means an entity that is organized under Chapter 167. of the Revised Code, section 9.833 of the Revised Code, an entity that is organized as a multi-employer welfare arrangement as defined by 29 USC 1002, or an entity that is organized as a voluntary employee benefits arrangement under IRC 501(c)(9).



Effective: 02/24/2011
R.C. 119.032 review dates: 12/31/2015
Promulgated Under: 119.03
Statutory Authority: 9.901
Rule Amplifies: 9.901
Prior Effective Dates: 1/1/2009