Ohio Administrative Code Search

... values, and to require the use of the "1980 Commissioners Standard Ordinary (CSO) Life Valuation Mortality Table" for use in determining the minimum standard of valuation of reserves and the minimum standard nonforfeiture values for preneed insurance products. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under sections 3901.041, 3903.72, 3903.721...

...pose The purpose of this rule is to: (1) Permit plans to include a coordination of benefits "(COB)" provision; (2) Provide the authority for the orderly transfer of information needed to pay claims promptly; (3) Eliminate duplication of benefits by permitting a plan to reduce benefits paid when, pursuant to this rule, it is not required to pay its benefits first; (4) Reduce claim payment ...

...pose The purpose of this rule is to: (1) Permit plans to include a coordination of benefits "(COB)" provision; (2) Provide the authority for the orderly transfer of information needed to pay claims promptly; (3) Eliminate duplication of benefits by permitting a plan to reduce benefits paid when, pursuant to this rule, it is not required to pay its benefits first; (4) Reduce claim payment ...

...in the superintendent under sections 3901.041, 3901.21 and 3902.22 of the Revised Code. (C) Definitions As used in this rule (1) "CDT codes" means the most current dental terminology and codes prescribed by the American dental association. (2) "Claim" means any request submitted to a third-party payer for benefits or proceeds under a benefit plan or contract on a standardized health claim for...

...in the superintendent under sections 3901.041, 3901.19 to 3901.26 and 3922.22 of the Revised Code. (C) Applicability and scope Except as otherwise provided, this rule shall apply to: (1) Health plan issuers as defined in section 3922.01 of the Revised Code; and (2) Independent review organizations as defined in section 3922.01 of the Revised Code seeking accreditation or accredited by the supe...

...in the superintendent under sections 3901.041, 3901.19 to 3901.26 and 3922.22 of the Revised Code. (C) Applicability and scope Except as otherwise provided, this rule applies to: (1) Health plan issuers as defined in section 3922.01 of the Revised Code; and (2) Independent review organizations as defined in section 3922.01 of the Revised Code seeking accreditation or accredited by the superint...

...in the superintendent under sections 3901.041, 3959.01 to 3959.16, and 3959.99 of the Revised Code. (C) Definitions. As used in this rule: (1) "Third party administrator" means any person that adjusts or settles claims in connection with life, dental, vision, health, prescription drugs, or disability insurance plans, self-insurance programs or other benefit plans for a sponsor of a plan if eithe...

...in the superintendent under sections 3901.041, 3959.01 to 3959.16, and 3959.99 of the Revised Code. (C) Definitions. As used in this rule: (1) "Third party administrator" means any person that adjusts or settles claims in connection with life, dental, vision, health, prescription drugs, or disability insurance plans, self-insurance programs or other benefit plans for a sponsor of a plan if eithe...

... in the superintendent under section 3901.041 of the Revised Code. (C) Applicability. This rule applies to all insurers permitted by Chapter 3901. of the Revised Code to require applicants for life or sickness and accident insurance coverage to submit to an HIV test. (D) Definitions. (1) "AIDS" means the illness designated as acquired immune deficiency syndrome. (2) "HIV" means the human immunodeficiency virus id...

... in the superintendent under section 3901.041 of the Revised Code. (C) Applicability This rule applies to all insurers permitted by Chapter 3901. of the Revised Code to require applicants for life or sickness and accident insurance coverage to submit to an HIV test. (D) Definitions (1) "AIDS" means the illness designated as acquired immune deficiency syndrome. (2) "HIV" means the human im...

...ous advertising media. Section 3923.16 of the Revised Code prohibits the use of any advertising copy, advertising plan, or plan of solicitation in connection with the solicitation of sickness or accident insurance which is materially misleading or deceptive. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Cod...

...in the superintendent under sections 3901.041, 3923.33 and 3923.331 to 3923.339 of the Revised Code. (C) Applicability and scope (1) Except as otherwise specifically provided in paragraphs (G), (P), (Q), (T), and (Y) of this rule, this rule shall apply to: (a) All medicare supplement policies, delivered or issued for delivery in this state on or after the effective date of this rule; and (b) A...

...in the superintendent under sections 3901.041, 3923.33 and 3923.331 to 3923.339 of the Revised Code. (C) Applicability and scope (1) Except as otherwise specifically provided in paragraphs (G), (P), (Q), (T), and (Y) of this rule, this rule applies to: (a) All medicare supplement policies, delivered or issued for delivery in this state on or after the effective date of this rule; and (b) All c...

...of insurance pursuant to section 3923.021 of the Revised Code. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code. (C) Definitions (1) "Notice" means a statement which sets forth at least the following: (a) The name and address of the insurer; (b) The date, time and place of the scheduled hearing; (c) The purpose of the heari...

... in the superintendent under section 3901.041 of the Revised Code. Sections 3901.20 and 3901.21 of the Revised Code, respectively, prohibit unfair or deceptive practices in the business of insurance and define certain acts or practices as unfair or deceptive. Section 3901.21 of the Revised Code also provides that the enumeration of specific unfair or deceptive acts or practices in the business of...

... in the superintendent under section 3901.041 of the Revised Code. Sections 3901.20 and 3901.21 of the Revised Code, respectively, prohibit unfair or deceptive practices in the business of insurance and define certain acts or practices as unfair or deceptive. Section 3901.21 of the Revised Code also provides that the enumeration of specific unfair or deceptive acts or practices in the business of...

... in the superintendent under section 3901.041 of the Revised Code. Sections 3901.20 and 3901.21 of the Revised Code, respectively, prohibit unfair or deceptive practices in the business of insurance and define certain acts or practices as unfair or deceptive. Section 3901.21 of the Revised Code also provides that the enumeration of specific unfair or deceptive acts or practices in the business of...

...nt statute, sections 3923.58 and 3923.581 of the Revised Code. This rule requires carriers to provide information to consumers, insurance agents and to the superintendent, pursuant to section 3923.582 of the Revised Code. The open enrollment requirements in this rule apply to any carrier that is in the business of issuing health benefit plans to individuals and/or non-employer groups. (B) Authori...

...nt statute, sections 3923.58 and 3923.581 of the Revised Code. This rule requires carriers to provide information to consumers, insurance agents and to the superintendent, pursuant to section 3923.582 of the Revised Code. The open enrollment requirements in this rule apply to any carrier that is in the business of issuing health benefit plans to individuals and/or non-employer groups. (B) Authori...

...plicable statutes including sections 3901.21 and 3923.16 of the Revised Code by further defining unfair trade practices and setting forth minimum standards for the adequate disclosure of any limitations or restrictions on access to providers/facilities to enrollees and to potential enrollees prior to enrollment in a particular health plan. (B) Authority This rule is promulgated pursuant to the a...

...plicable statutes including sections 3901.21 and 3923.16 of the Revised Code by further defining unfair trade practices and setting forth minimum standards for the adequate disclosure of any limitations or restrictions on access to providers/facilities to enrollees and to potential enrollees prior to enrollment in a particular health plan. (B) Authority This rule is promulgated pursuant to the a...

...E) Definitions As used in this rule: (1) "Ambulance" has the same meaning as in section 4765.01 of the Revised Code. (2) "Clinical laboratory services" has the same meaning as in section 4731.65 of the Revised Code. (3) "Cost sharing" means the cost to a covered person under a health benefit plan according to any copayment, coinsurance, deductible, or other out-of-pocket expense requiremen...

...nt of insurance pursuant to sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.05, and 3916.20 of the Revised Code. (C) Applicability and scope This rule applies to all persons applying for or renewing a license or who are currently licensed as a viatical settlement provider in this state. (D) Definitions The definitions set forth in Chapter 3916. of the Revised Code are incorporated by reference herein. The ...

...nt of insurance pursuant to sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.05, and 3916.20 of the Revised Code. (C) Applicability and scope This rule applies to all persons applying for or renewing a license or who are currently licensed as a viatical settlement broker in this state and to all persons licensed as a life insurance agent registering or registered to operate as a viatical settle...

...ement brokers pursuant to Chapter 3916. of the Revised Code. (B) Authority This rule is issued pursuant to the authority vested in the superintendent under sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.03, and 3916.20 of the Revised Code. (C) Application and scope This rule applies to all persons applying to provide, providing, or enrolled in a viatical settlement education course or p...