Ohio Revised Code Search

...(A)(1) An insurer or insurance group shall have discretion regarding the format of its corporate governance annual disclosure. (2) The CGAD shall be prepared consistent with the rules adopted by the superintendent pursuant to section 3901.077 of the Revised Code regarding the required content of the CGAD and shall contain the material information necessary for the superintendent to gain an understanding of the insu...

...ng conducted in accordance with Chapter 119. of the Revised Code, that an insurer has failed to file a corporate governance annual disclosure as required by division (A) of section 3901.073 of the Revised Code, the superintendent shall assess a civil penalty against the insurer. (1) The amount of the civil penalty imposed by division (A) of this section shall be one hundred dollars for each day the CGAD is past due...

...(A) As used in sections 3901.212 to 3901.213 of the Revised Code, "consumer" means a policyholder, potential policyholder, certificate holder, potential certificate holder, insured, potential insured, or applicant. (B) The superintendent may adopt rules pursuant to Chapter 119. of the Revised Code to implement the practices set forth in section 3901.213 of the Revised Code to ensure consumer protection. Such regula...

...isdiction over both of the following: (1) Every person that is not a resident or domiciliary of, nor authorized to do business in, this state, and that files a statement with the superintendent of insurance under section 3901.321 of the Revised Code; (2) All actions involving such person arising out of violations of section 3901.321 of the Revised Code. (B) Each person described in division (A) of this section is ...

...(A)(1) In addition to the powers that the superintendent has under sections 3901.01 to 3901.31 of the Revised Code, relating to the examination of insurers, the superintendent of insurance, subject to sections 119.01 to 119.13 of the Revised Code, shall also have the power to examine any insurer registered under section 3901.33 of the Revised Code and its affiliates to ascertain the financial condition of the ...

...s used in this section and sections 3901.381 to 3901.3814 of the Revised Code: (A) "Beneficiary" means any policyholder, subscriber, member, employee, or other person who is eligible for benefits under a benefits contract. (B) "Benefits contract" means a sickness and accident insurance policy providing hospital, surgical, or medical expense coverage, or a health insuring corporation contract or other policy or agr...

...uant to the requirements of sections 3901.381 to 3901.388 of the Revised Code. The third-party payer must make an election to process such claims either within the ninety-day period or under section 3901.381 of the Revised Code. If the claim is denied, the third-party payer shall notify the provider and the beneficiary. The notice shall state, with specificity, why the third-party payer denied the claim. (B) The thi...

...provider in accordance with sections 3901.381 to 3901.386 of the Revised Code shall be considered final two years after payment is made. After that date, the amount of the payment is not subject to adjustment, except in the case of fraud by the provider. (B) A third-party payer may recover the amount of any part of a payment that the third-party payer determines to be an overpayment if the recovery process is initia...

...er that fails to comply with section 3901.381 of the Revised Code, or any contractual payment arrangement entered into under section 3901.383 of the Revised Code, shall pay interest in accordance with this section. (B) Interest shall be computed based upon the number of days that have elapsed between the date payment is due in accordance with section 3901.381 of the Revised Code or the contractual payment arrangemen...

...lings required under this section. (E)(1) In addition to the annual statement required to be filed with the national association of insurance commissioners under division (B) of this section, the superintendent may require an insurer to file with the superintendent, on or before the forty-fifth day following the last day of each calendar quarter, quarterly reports showing its condition for each of the first three ca...

...e following conditions are satisfied: (1) The securities shall be under the control of the superintendent of insurance; (2) The securities shall not be withdrawn by the insurance company without the written approval of the superintendent; (3) The placement shall be made pursuant to a written agreement between the insurance company and a direct participant or member bank. The agreement shall be approved in writing ...

...rued to violate division (E) of section 1751.31 or division (G) of section 3901.21 of the Revised Code if the program is disclosed in the policy or plan. The insured may be required to provide verification, such as a statement from the individual's physician, certified nurse-midwife, clinical nurse specialist, or certified nurse practitioner, that a medical condition makes it unreasonably difficult or medically ina...

...Sections 3901.67 to 3901.70 of the Revised Code apply to all of the following: (A) Asset acquisitions, including every purchase, lease, exchange, merger, consolidation, succession, or other acquisition other than the construction or development of real property by or for the reporting insurer, or the acquisition of materials for such purpose. (B) Asset dispositions, including every sale, lease, exchange, merger, co...

...(A) As used in this section: (1) "Living organ donor" means a living person who donates an organ to another living person. (2) "Policy of insurance" means a life insurance policy, disability insurance policy, or long-term care insurance policy. (B) Notwithstanding any provision of law to the contrary, an insurer shall not unfairly discriminate against a living organ donor in the offering, issuance, premium,...

...As used in this section and sections 3901.811 to 3901.815 of the Revised Code: (A) "Auditing entity" means any person or government entity that performs a pharmacy audit, including a payer, a pharmacy benefit manager, or a third-party administrator licensed under Chapter 3959. of the Revised Code. (B) "Business day" means any day of the week excluding Saturday, Sunday, and a legal holiday, as defined in section 1.1...

...ces by using either of the following: (1) An original pharmacy record or photocopy of the record; (2) An original prescription or photocopy of the prescription in any form that constitutes a valid prescription in this state, including a written prescription, a prescription made through an electronic prescribing system, a prescription delivered by facsimile, a prescription made by issuing an order for medication adm...

... after a pharmacy audit is completed: (1) A pharmacy shall be given not less than thirty days from the date of the on-site audit to provide the auditing entity any additional information necessary to complete the preliminary audit report. (2) Not later than sixty business days after the audit is completed, the auditing entity shall deliver a preliminary audit report to the pharmacy that was the subject of the audit...

... in this state. (B) Beginning on July 1, 1993, twenty per cent of the amount that is collected under division (A) of this section from foreign insurance companies that sell fire insurance to residents of this state shall be paid into the state fire marshal's fund created under section 3737.71 of the Revised Code. The director of commerce, with the approval of the director of budget and management, may increase the ...

...tion. (B) As used in this section: (1) "Nontherapeutic abortion" has the same meaning as in section 9.04 of the Revised Code. (2) "Qualified health plan" means any qualified health plan as defined in section 1301 of the "Patient Protection and Affordable Care Act," 42 U.S.C. 18021, offered in this state through an exchange created under that act.

...(A) Whoever violates section 3901.09 of the Revised Code shall be fined not less than twenty-five nor more than five hundred dollars. (B) Whoever violates any law relating to the superintendent of insurance, or any law of this state relating to insurance as defined in division (A)(1) of section 3901.04 of the Revised Code, for the violation of which no penalty is otherwise provided in the Revised Code, shall be fine...

...ing ease score required in division (A)(1) of section 3902.04 of the Revised Code whenever, in his discretion, he finds that a lower score meets any of the following conditions: (A) The lower score will provide a more accurate reflection of the readability of a policy form; (B) The lower score is warranted by the nature of a particular policy form or type or class of policy forms; (C) The lower score is caused by ...

...As used in sections 3902.11 to 3902.14 of the Revised Code: (A) "Beneficiary" and "third-party payer" have the same meanings as in section 3901.38 of the Revised Code. (B) "Plan of health coverage" means any of the following if the policy, contract, or agreement contains a coordination of benefits provision: (1) An individual or group sickness and accident insurance policy, which policy provides for hospital, d...

...(A)(1) Except as provided in division (A)(2) of this section, sections 3901.38 to 3901.3814 of the Revised Code shall not apply with respect to a claim during a period of negotiation under section 3902.51 of the Revised Code or a period of arbitration under section 3902.52 of the Revised Code. Sections 3901.38 to 3901.3814 of the Revised Code shall apply upon the completion of a successful negotiation or upon the ren...

...ain any of the following provisions: (1) A reimbursement rate for a prescription drug that is less than the national average drug acquisition cost rate for that drug as determined by the United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition c...

...(A) Sections 3903.01 to 3903.59 of the Revised Code may be cited as "the insurers supervision, rehabilitation, and liquidation act." (B) Sections 3903.01 to 3903.59 of the Revised Code do not limit the powers granted the superintendent of insurance under any other section of the Revised Code. (C) Sections 3903.01 to 3903.59 of the Revised Code shall be liberally construed to effect the purpose stated in division (D...