Ohio Revised Code Search

...de, section 3923.33 and sections 3923.331 to 3923.339 of the Revised Code shall apply to: (1) All medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this amendment; and (2) All certificates issued under group medicare supplement policies, which certificates are delivered or issued for delivery in this state on or after the effective date of this amendment. ...

... to which all of the following apply: (1) The policy covers a specified disease or a limited plan of coverage. (2) The policy is specifically designed, advertised, represented, and sold as a supplement to other basic sickness and accident insurance coverage. (3) The entire premium for the policy is paid by the insured, the insured's family, or the insured's guardian. (B) This section applies to supplemental sickn...

...(A) As used in this section: (1) "Consolidated corporation" means any mutual insurance company that merged or consolidated with a hospital service association. (2) "Individual policy" means a policy other than a policy issued pursuant to section 3923.11, 3923.12, or 3923.13 of the Revised Code. (3) "Individual policyholder" means a person who is an insured under an individual policy. (4) "Cancel" means any cancel...

...newed in this state on or after January 1, 1989, unless the policy covers adopted children of the insured on the same basis as other dependents. The coverage required by this section is subject to the requirements and restrictions set forth in section 3924.51 of the Revised Code.

...ed in division (D)(3) of section 3923.41 of the Revised Code, shall file evidence with the superintendent of insurance that the association has at the outset a minimum of one hundred persons and has been organized and maintained in good faith for purposes other than that of obtaining insurance, has been in active existence for at least one year, and has a constitution and bylaws that provide all of the followin...

...t adhering to one of the following: (1) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim if the insurer can demonstrate that the insured misrepresented facts that were material to the insurer's offer of coverage to the insured. (2) For a policy or certi...

...ection 3923.56 of the Revised Code: (1) "Child health supervision services" means periodic review of a child's physical and emotional status performed by a physician, by a health care professional under the supervision of a physician, or, in the case of hearing screening, by an individual acting in accordance with section 3701.505 of the Revised Code. (2) "Periodic review" means a review performed in accorda...

...ce with division (B) of this section: (1) The frequency of the determination of the usual and customary fee; (2) A general description of the methodology used to determine usual and customary fees; (3) The geographic area used to determine usual and customary fees; (4) If the usual and customary fee for a service is determined by taking a sample of fees submitted on actual claims from dentists and then selecting ...

...(A) Notwithstanding section 3901.71 of the Revised Code, no health benefit plan or public employee benefit plan shall deny coverage for the costs of any routine patient care administered to an insured participating in any stage of an eligible cancer clinical trial, if that care would be covered under the plan if the insured was not participating in a clinical trial. (B) T...

...viders. (C) As used in this section: (1) "Health benefit plan" means any policy of sickness and accident insurance or any policy, contract, or agreement covering one or more "basic health care services," "supplemental health care services," or "specialty health care services," as defined in section 1751.01 of the Revised Code, offered or provided by a health insuring corporation or by a sickness and accident insure...

...as the same meaning as in section 3924.01 of the Revised Code. (B) Notwithstanding section 3901.71 of the Revised Code, no health benefit plan or public employee benefit plan shall contain a provision that limits or excludes an insured's coverage under the plan for a loss or expense the insured sustains that is the result of the insured's use of alcohol or other drugs or both and the loss or expense is ot...

...e the same meanings as in section 3963.01 of the Revised Code. (B) A sickness and accident insurer or public employee benefit plan shall provide the information required in this division to all insured individuals receiving coverage under an individual or group policy of sickness and accident insurance or public employee benefit plan for vision care services, vision care materials, or dental care services. The info...

...uding any of the following services: (1) Managing drug therapy under a consult agreement pursuant to section 4729.39 of the Revised Code; (2) Administering immunizations in accordance with section 4729.41 of the Revised Code; (3) Administering drugs in accordance with section 4729.45 of the Revised Code. (B) The patient's individual or group policy of sickness and accident insurance or public employee benefit...

...g to the superintendent of insurance: (1) The carrier does not have the financial reserves necessary to underwrite additional coverage. (2) The carrier is applying division (A) of this section uniformly to all employers in the small employer market in this state consistent with the applicable laws and rules of this state and without regard to the claims experience of those employers and their employees and dependen...

...materials, the following information: (1) The provisions of the plan concerning the carrier's right to change premium rates and the factors that may affect changes in premium rates; (2) The provisions of the plan relating to renewability of coverage; (3) The provisions of the plan relating to any pre-existing condition exclusion; (4) The benefits and premiums available under all health benefit plans for which the...

...equirements contained in sections 3924.01 to 3924.06 of the Revised Code shall be demonstrated through actuarial certification. Carriers offering health benefit plans to small employers shall file annually with the superintendent of insurance an actuarial certification stating that the underwriting and rating methods of the carrier do all of the following: (1) Comply with accepted actuarial practices; (2) Are un...

...(A) As used in this section: (1) "Beneficiary," "hospital," and "third-party payer" have the same meanings as in section 3901.38 of the Revised Code. (2) "Overcharged" means charged more than the usual and customary charge, rate, or fee that is charged by the provider or hospital for a particular item or service. (3) "Provider" has the same meaning as in section 3902.11 of the Revised Code. (B) If a beneficiary ...

...(A) As used in this section: (1) "Carrier," "dependent," and "health benefit plan" have the same meanings as in section 3924.01 of the Revised Code. (2) "Health status-related factor" means any of the following: (a) Health status; (b) Medical condition, including both physical and mental illnesses; (c) Claims experience; (d) Receipt of health care; (e) Medical history; (f) Genetic information; (g) Evidence o...

...as the same meaning as in section 3924.41 of the Revised Code. (B) No health insurer shall deny enrollment of a child under the health plan of the child's parent on the basis that any of the following applies: (1) The child was born out of wedlock. (2) The child is not claimed as a dependent on the federal tax return of the parent. (3) The child does not reside in the household of the parent, or in the service ar...

...(A) As used in this section: (1) "Child" means, in connection with any adoption or placement for adoption of the child, an individual who has not attained age eighteen as of the date of the adoption or placement for adoption. (2) "Health insurer" has the same meaning as in section 3924.41 of the Revised Code. (3) "Placement for adoption" means the assumption and retention by a person of a legal obligation for tota...

...(A) As used in this section: (1) "Beneficiary" and "benefits contract" have the same meanings as in section 3901.38 of the Revised Code. (2) "Confinement" means any period of time during which a person is in the custody or under the supervision of the department of rehabilitation and correction or is confined in a local jail, workhouse, or other correctional facility of the type described in section 307.93, 341.14,...

...As used in sections 3924.61 to 3924.74 of the Revised Code: (A) "Account holder" means the natural person who opens a medical savings account or on whose behalf a medical savings account is opened. (B) "Eligible medical expense" means any expense for a service rendered by a licensed health care provider or a Christian Science practitioner, or for an article, device, or drug prescribed by a licensed health care prov...

...administered by one of the following: (1) A federally or state-chartered bank, savings and loan association, savings bank, or credit union; (2) A trust company authorized to act as a fiduciary; (3) An insurer authorized under Title XXXIX of the Revised Code to engage in the business of sickness and accident insurance; (4) A dealer or salesperson licensed under Chapter 1707. of the Revised Code; (5) An administra...

...r continue to administer the account. (1) If the administrator agrees to continue to administer the account, funds in the account may continue to be used to pay the eligible medical expenses of the account holder and the account holder's spouse and dependents, pursuant to sections 3924.61 to 3924.74 of the Revised Code. If the account holder later becomes employed by a new employer that opens a new medical savings ...

...r an attorney licensed under section 3931.10 of the Revised Code to make reciprocal or interinsurance contracts under sections 3931.01 to 3931.12 of the Revised Code, may directly, or by ceding or assuming reinsurance, transact any of the following kinds of insurance: (1) Fire; (2) Allied lines; (3) Farmowners multiple peril; (4) Homeowners multiple peril; (5) Commercial multiple peril; (6) Ocean marine; (7) I...