Ohio Revised Code Search

...payer may do either of the following: (1) Enter into a contractual agreement under which time periods shorter than those set forth in section 3901.381 of the Revised Code are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider; (2) Enter into a contractual agreement under which the timing of payments by the third-party payer is not directly rel...

...he time periods specified in section 3901.381 of the Revised Code have elapsed for the original claim submitted, the third-party payer may deny the duplicative claim. Denials of claims determined to be duplicative by the department of insurance shall not be considered by the department in a market conduct examination of a third-party payer's compliance with section 3901.381 of the Revised Code. The superintendent of ...

...(A) As used in this section: (1) "Health benefit plan" means a policy, contract, certificate, or agreement entered into, offered, or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a vision or dental benefit plan. "Health benefit plan" does not include any of the following: (a) A plan of self-insurance; (b) Insurance arising out of...

...(A) As used in this section: (1) "Genetic screening or testing" means a laboratory test of a person's genes or chromosomes forgenotypes, mutations, or chromosomal changes, including carrier status, that are linked to physical or mental disorders or impairments, or that indicate a susceptibility to illness, disease, or other disorders, whether physical or mental, which test is a direct test for genotypes, mutations,...

...(A) As used in this section: (1) "Genetic screening or testing" means a laboratory test of a person's genes or chromosomes for genotypes, mutations, or chromosomal changes, including carrier status, that are linked to physical or mental disorders or impairments, or that indicate a susceptibility to illness, disease, or other disorders, whether physical or mental, which test is a direct test for genotypes, mutations...

...nt of insurance pursuant to sections 3901.67 to 3901.70 of the Revised Code is confidential and privileged and is not subject to subpoena. Except as provided in division (B) of this section, the report shall not be made public by the superintendent or any other persons. (B) Notwithstanding division (A) of this section, the superintendent may do any of the following: (1) Disclose a report that is the subject of th...

...s must be approved under sections 3902.01 to 3902.08 of the Revised Code, unless: (1) The text achieves a minimum score of forty on the Flesch reading ease test, or an equivalent score on any other comparable test as provided in division (C) of this section; (2) It is printed, except for specification pages, schedules, and tables, in not less than ten-point type, one point leaded; (3) The style, arrangement, and o...

...(A) As used in this section: (1) "Health benefit plan" and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code. (2) "Mental Health Parity and Addiction Equity Act" means the federal "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008," Pub. L. No. 110-343, as amended, and any federal regulations implementing that act. (B) Each health plan iss...

...as the same meaning as in section 4765.01 of the Revised Code. (B) "Clinical laboratory services" has the same meaning as in section 4731.65 of the Revised Code. (C) "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 requirement. (D) "Covered" or "coverage" means the provision of benefits related to he...

...(A)(1) If a negotiation undertaken pursuant to division (B)(2) of section 3902.51 of the Revised Code has not successfully concluded within thirty days, or if both parties agree that they are at an impasse, the provider, facility, emergency facility, or ambulance may send a request for arbitration to the superintendent of insurance and shall notify the health plan issuer of its request. To be eligible for arbitration...

...(A) Notwithstanding section 3901.71 and sections 3901.831 to 3901.833 of the Revised Code, a health benefit plan issued, delivered, or renewed in this state on or after the effective date of this section that directly or indirectly covers the treatment of stage four advanced metastatic cancer shall not make coverage of a drug that is prescribed to treat such cancer or associated conditions dependent upon a covered pe...

... in any proceeding under sections 3903.01 to 3903.59 of the Revised Code or any investigation preliminary to the proceeding. The term "person" as used in this section includes, but is not limited to, any person who exercises control directly or indirectly over activities of an insurer through any holding company or other affiliate of the insurer. "To cooperate" includes, but is not limited to, a duty to do both of th...

... provisions for all of the following: (1) Reserving amounts for the payment of expenses of administration and the payment of claims of secured creditors, to the extent of the value of the security held, and claims falling within the priorities established in divisions (B) and (D) of section 3903.42 of the Revised Code; (2) Disbursement of the assets marshalled to date and subsequent disbursement of assets as they b...

...bution of claims shall be: (A) Class 1. The costs and expenses of administration, including but not limited to the following: (1) The actual and necessary costs of preserving or recovering the assets of the insurer; (2) Compensation for all services rendered in the liquidation; (3) Any necessary filing fees; (4) The fees and mileage payable to witnesses; (5) Reasonable attorney's fees; (6) The reasonab...

...governed by the following provisions: (1) The opinion shall be in form and substance as specified in the valuation manual and acceptable to the superintendent. (2) The opinion shall be submitted with the annual statement reflecting the valuation of such reserve liabilities for each year ending on or after the operative date of the valuation manual. (3) The opinion shall apply to all policies and contracts subj...

...s specified in the valuation manual: (1) The principle-based valuation shall quantify the benefits and guarantees, and the funding, associated with the contracts and their risks at a level of conservatism that reflects conditions that include unfavorable events that have a reasonable probability of occurring during the lifetime of the contracts. (2) The principle-based valuation shall reflect conditions, for ...

...(A) For purposes of sections 3903.81 to 3903.93 of the Revised Code, a "mandatory control level event" is any of the following events: (1) The filing of an RBC report by an insurer that indicates that the insurer's total adjusted capital is less than its mandatory control level RBC; (2) The notification by the superintendent of insurance to an insurer of an adjustment to the insurer's RBC report, which adjusted RBC...

...(A) The obligations of sections 3904.01 to 3904.22 of the Revised Code apply to those insurance institutions, agents, or insurance support organizations that, on or after the effective date of these sections, do either of the following: (1) Collect, receive, or maintain information in connection with insurance transactions that pertains to natural persons who are residents of this state; (2) Engage in insurance tra...

...or the superintendent's designee. (B)(1) If a person licensed as an insurance agent under section 3905.06 of the Revised Code changes the person's home state, the person shall, within thirty days after making that change, file a change of address with the superintendent and provide the superintendent with certification from the new home state. (2) If a resident insurance agent complies with division (B)(1) o...

...of the following conditions are met: (1) The limited lines travel insurance agent or travel retailer provides all of the following information to purchasers of travel insurance at the time of sale or in the fulfillment materials provided to purchasers: (a) A description of the material terms or the actual terms of the insurance coverage; (b) A description of the process for filing a claim; (c) A description o...

...nses in good standing in this state: (1) Property and casualty license; (2) Managing general agent license; (3) Third-party administrator license. (B)(1) A travel insurer is responsible for the acts of a travel administrator administering travel insurance underwritten by the travel insurer and is responsible for ensuring that the travel administrator maintains all books and records relevant to the travel ins...

...urrendered for cause under section 3905.14 of the Revised Code, except for a person whose license was denied for a disqualifying offense pursuant to section 9.79 of the Revised Code, the superintendent of insurance shall hold a hearing to determine whether the administrative action imposing the denial, suspension, revocation, or surrender should be modified, provided that all of the following conditions are met: (1...

...t forth in division (B) of section 3905.14 of the Revised Code, the insurer or authorized representative of the insurer shall promptly notify the superintendent, in the manner prescribed by the superintendent, of any additional information the insurer discovers upon further review or investigation, which information would have been provided to the superintendent in accordance with division (A) of this section had the...

...dmitted and Reinsurance Reform Act of 2010," 15 U.S.C. 8201 et seq., 124 Stat. 1589, or any successor or replacement law, where this state is the home state of the insured, an insurer shall be considered eligible to write insurance on an unauthorized basis in this state if any of the following are true: (1) The insurer meets the requirements and criteria in sections 5A(2) and 5C(2)(a) of the nonadmitted insurance m...

...computed as set forth in section 5725.221 of the Revised Code shall be made on the entire sum of the tax plus penalty, which interest shall be computed from the date the tax is due until it is paid. For purposes of this section, payment is considered made when it is received by the treasurer or the superintendent, irrespective of any United States postal service marking or other stamp or mark indicating the dat...