Ohio Administrative Code Search

...thority vested in the superintendent of insurance under section 3901.041 of the Revised Code, general rule making authority; and sections 3901.19 to 3901.22 of the Revised Code, the unfair and deceptive acts statute. (C) Definitions (1) "Discount" means any negotiated reduction or variation from the schedule of billed charges (including capitation) that a health care provider otherwise would require a patient and/o...

...thority vested in the superintendent of insurance under sections 3901.041 and 3901.19 to 3901.22 of the Revised Code. (C) Definitions (1) "Discount" means any negotiated reduction or variation from the schedule of billed charges (including capitation) that a health care provider otherwise would require a patient and/or the patient's third party payer to pay to that health care provider. (2) "Bi...

...5) "CMS form 1450" means the health insurance claim form published by CMS for use by institutional care practitioners. For purposes of this rule, the CMS form 1450 includes the UB-04 form and its successors. (6) "CMS form 1500" means the health insurance claim form published by CMS for use by health care practitioners. For purposes of this rule, the CMS form 1500 includes successor forms as a...

..., prescription drugs, or disability insurance plans, self-insurance programs or other benefit plans for a sponsor of a plan if either the sponsor or the plan is domiciled in this state or has its principal headquarters or principal administrative offices in this state. "Third party administrator" includes a pharmacy benefit manager. "Third party administrator" does not include any of the foll...

..., prescription drugs, or disability insurance plans, self-insurance programs or other benefit plans for a sponsor of a plan if either the sponsor or the plan is domiciled in this state or has its principal headquarters or principal administrative offices in this state. "Third party administrator" includes a pharmacy benefit manager. "Third party administrator" does not include any of the foll...

...cants 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 identified as the causative agent of AIDS. (3) "HIV test" means any test for the antibody or antigen to HIV that has been approved by the director of health under division (B) of sectio...

...s 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 identified as the causative agent of AIDS. (3) "HIV test" means any test for the antibody or antigen to HIV that has been approved by the director of health under...

... advertising of sickness and accident insurance. This purpose is intended to be accomplished by the establishment of, and adherence to, certain minimum standards and guidelines of conduct in the advertising of sickness and accident insurance in a manner which prevents unfair competition among insurers and is conducive to the accurate presentation and description for the insurance buying public o...

... in the sale of sickness and accident insurance coverage to persons eligible for medicare. (B) Authority This rule is promulgated pursuant to the authority vested 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, ...

... in the sale of sickness and accident insurance coverage to persons eligible for medicare. (B) Authority This rule is promulgated pursuant to the authority vested 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, ...

...pplemental sickness and accident health insurance policy by providing for the regulation of the solicitation and sale of medicare supplemental accident and health insurance policies; and to assure that medicare-eligible persons are not subjected to unfair or deceptive acts or practices in the solicitation and sale of medicare supplemental accident and health insurance policies by defining addition...

...ring scheduled by the superintendent 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 h...

...contracts issued pursuant to Ohio's insurance statutes, rules and regulations under Titles XVII and XXXIX of the Revised Code. Nothing herein shall be construed to create or imply a private cause of action for violation of this rule. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code. Sections 3901.20 and 3901...

...contracts issued pursuant to Ohio's insurance statutes, rules and regulations under Titles XVII and XXXIX of the Revised Code. Nothing herein shall be construed to create or imply a private cause of action for violation of this rule. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code. Sections 3901.20 and 3901...

...contracts issued pursuant to Ohio's insurance statutes, rules and regulations under Titles XVII and XXXIX of the Revised Code. Violation of this rule does not create or imply a private cause of action. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code. Sections 3901.20 and 3901.21 of the Revised Code, res...

...rs 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) Authority This rule is promulgated pursuant to the authority stated in sections 3901.041 and 3...

...rs 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) Authority This rule is promulgated pursuant to the authority stated in sections 3901.041 and 3...

...shall mean an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offers to contract, to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefit plan, including a sickness and accident insurance company; a health insuring corporation; a frater...

...rule means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offers to contract, to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefit plan, including a sickness and accident insurance company; a health insuring corporation; a frater...

...authority granted the superintendent 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 inco...

... license and to the registration of insurance agents operating as a viatical settlement broker. This rule also provides form filing requirements and fees for licenses, renewals, and form approvals. (B) Authority This rule is promulgated under the authority granted the superintendent of insurance pursuant to sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.05, and 3916.20 of the Revised Code...

...o be approved by the Ohio department of insurance as an acceptable viatical settlement broker education course, at a minimum, the course must: (a) Be offered by an approved provider; (b) Use the most recent versions of laws and rules; (c) Have significant intellectual or practical content that enhances and improves the licensee's knowledge or professional competence. A course should be an organized pro...

...his rule is to provide guidance to life insurance companies regarding the types of questions that must be included on life insurance applications pursuant to division (B) of section 3916.05 of the Revised Code to identify and prevent stranger-originated life insurance (STOLI). (B) Authority This rule is adopted pursuant to sections 3901.04, 3901.041, 3916.05 and 3916.20 of the Revised Code. (C) Applicability and s...

...m and license an Ohio domiciled captive insurance company pursuant to section 3964.03 of the Revised Code. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3964.21 of the Revised Code. (C) Form of application The superintendent of insurance shall post on the department of insurance website the forms to be used in applying for a license as an Ohio domicile...

...d license an Ohio domiciled captive insurance company pursuant to section 3964.03 of the Revised Code. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3964.21 of the Revised Code. (C) Information to be provided In addition to the information required to be filed pursuant to division (D) of section 3964.03 of the Revised Code, an a...