Ohio Revised Code Search

...ny 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, dental, surgical, or medical services; (2) Any individual or group contract of a health insuring corporation, which contract provides for hospital, dental, surgical, or medical services; (3) Any other individu...

...When a plan of health coverage is primary, its benefits are paid without regard to the benefits of another plan. When a plan of health coverage is secondary, its benefits are determined by taking into consideration the payments made or to be made by another plan. When there are more than two plans, a plan may be primary as to one and may be secondary as to another.

...is determined to be a secondary plan it acts to provide benefits in excess of those provided by the primary plan. (C) The secondary plan shall not be required to make payment in an amount which exceeds the amount it would have paid if it were the primary plan, but in no event, when combined with the amount paid by the primary plan, shall payments by the secondary plan exceed one hundred per cent of expenses allowabl...

...The superintendent of insurance may, pursuant to Chapter 119. of the Revised Code, adopt rules to carry out the purposes of sections 3902.11 to 3902.14 of the Revised Code.

...As used in sections 3902.22 and 3902.23 of the Revised Code, "third-party payer" has the same meaning as in section 3901.38 of the Revised Code.

...The superintendent of insurance shall develop a standard claim form to be used by all third-party payers and providers for reimbursement of health care services and supplies, taking into consideration the special needs of, and differences between, third-party payers. The standard claim form shall be prescribed in rules the superintendent shall adopt in accordance with Chapter 119. of the Revised Code. The superinte...

...Beginning one hundred eighty days after rules adopted under section 3902.22 of the Revised Code take effect, no third-party payer shall fail to use the standard claim form prescribed in those rules.

...(A) As used in this section: (1) "Cost sharing" means the cost to a covered individual under a health benefit plan according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the plan. (2) "Health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code. (3) "Health care prof...

...ayer and a provider is void and against public policy if it does either of the following: (a) Establishes a minimum amount that the provider is required to charge an individual for a health service when that individual pays in full for the service; (b) Prohibits a provider from advertising the provider's rates for a service. (2) Division (B)(1)(b) of this section shall not be construed as prohibiting a provisio...

...ntal 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 issuer and health benefit plan subject to the Mental Health Parity and Addiction Equity Act shall comply with all applicable requirements of that act. The requi...

... being stabilized. (I) "Health care practitioner" has the same meaning as in section 3701.74 of the Revised Code. (J) "Pharmacy benefit manager" has the same meaning as in section 3959.01 of the Revised Code. (K) "Prior authorization requirement" means any practice implemented by a health plan issuer in which coverage of a health care service, device, or drug is dependent upon a covered person or a provider obt...

...B of Title XVIII of the Social Security Act, 42 U.S.C. 1395, as amended, for the service in question, excluding any in-network cost sharing imposed under the health benefit plan. (2) In lieu of accepting reimbursement under division (B)(1) of this section, a provider, facility, emergency facility, or ambulance may notify the health plan issuer that the provider, facility, emergency facility, or ambulance wishes to ...

...is section are confidential, not public records for the purposes of section 149.43 of the Revised Code, and shall not be released except as authorized pursuant to this division. If release of the evidence is required pursuant to a court order, the arbitrator shall release the evidence pursuant to the court order but shall redact from the evidence released information that constitutes intellectual property, trade secr...

... plan issuer is an unfair and deceptive act or practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code. (C) A provider who violates section 3902.51 or 3902.52 of the Revised Code shall be subject to professional discipline under Title XLVII of the Revised Code as applicable.

... superintendent of insurance shall contract with a single arbitration entity to perform all arbitrations described in section 3902.52 of the Revised Code. The superintendent shall ensure that the arbitration entity, any arbitrators the arbitration entity designates to conduct an arbitration, and any officer, director, or employee of the arbitration entity do not have any material, professional, familial, or financial...

...d, in the judgment of the health care practitioner in question, jeopardize the health of a covered individual if left untreated. (B) "Stage four advanced metastatic cancer" means a cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body.

...biologics compendium. (2) The best practices for the treatment of stage four advanced metastatic cancer, as supported by peer-reviewed medical literature. (C) A violation of this section is an unfair and deceptive practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.

...(A) As used in this section, "licensed health professional authorized to prescribe drugs" has the same meaning as in section 4729.01 of the Revised Code. (B) Notwithstanding section 3901.71 of the Revised Code, if a health plan issuer covers a prescription drug under a health benefit plan, the health plan issuer shall also provide coverage for that drug when it is dispensed by a pharmacist to a covered person in ac...

...r 4755. of the Revised Code or a chiropractor licensed under Chapter 4734. of the Revised Code shall not be greater than the cost-sharing requirement imposed by the plan for an office visit to a primary care physician or primary care osteopath physician licensed pursuant to Chapter 4731. of the Revised Code. (B) A health plan issuer shall clearly state on its web site and on all relevant literature that coverage f...

...ogist" means a licensed physician who practices otolaryngology. (3) "Related services" means services necessary to assess, select, and appropriately adjust or fit a hearing aid to ensure optimal performance. (B) On and after the effective date of this section, and notwithstanding section 3901.71 of the Revised Code, a health benefit plan shall provide coverage for the full cost of both of the following: (1) One...

...As used in this section and section 3902.71 of the Revised Code: (A) "340B covered entity" and "third-party administrator" have the same meanings as in section 5167.01 of the Revised Code. (B) "Terminal distributor of dangerous drugs" has the same meaning as in section 4729.01 of the Revised Code.

...effective date of this section , a contract entered into between a health plan issuer, including a third-party administrator, and a 340B covered entity shall not contain 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, measure...

...rt programs whether sponsored by a manufacturer, foundation, or other entity. (2) Except as may be required by law, interfere with, prevent, or materially discourage access, exchange, or use of the data required under division (B) of this section, including any of the following: (a) Charging fees; (b) Not responding to a request at the time the request is made, if such a response is reasonably possible; (c) I...

...h agencies, hospitals, medical clinics, public health agencies, rehabilitation agencies, and skilled nursing facilities. (P) "Medical professional" means any person licensed or certified to provide health care services to natural persons, including a chiropractor, clinical dietitian, clinical psychologist, dentist, nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, ps...

... known mailing address, as shown in the records of the insurance institution, agent, or insurance support organization, is located in this state.