Ohio Revised Code Search

...ependents the following types of fringe benefits: (1) Group or individual insurance contracts which may include life, sickness, accident, disability, annuities, endowment, health, medical expense, hospital, dental, surgical and related coverage or any combination thereof; (2) Group or individual contracts with health insuring corporations or other providers of professional services, care, or benefits duly authorize...

...(A) As used in this section, "health benefit plan," "health plan issuer," and "health care services" have the same meanings as in section 3922.01 of the Revised Code. (B) If a patient is admitted to a hospital for inpatient health care services and the hospital is informed at the time of admission that the person is covered by a health benefit plan, the hospital shall notify the health plan issuer of the admission ...

...federal program that offers health care benefits and that payer or program has determined that it is not responsible for the cost of the health care services. When a claim is submitted later than one year after the last date of service for which reimbursement is sought under the claim, the third-party payer shall pay or deny the claim not later than ninety days after receipt of the claim or, alternatively, pursuant t...

...cancel, refuse to issue or renew, limit benefits under, or set premiums for a sickness and accident insurance policy or public employee benefit plan. (C) Any insurer or plan that has engaged in, is engaged in, or is about to engage in a violation of division (B) of this section is subject to the jurisdiction of the superintendent of insurance under section 3901.04 of the Revised Code.

...ongoing basis, and consider the rights, benefits, and the extent of reciprocal recognition afforded by the jurisdiction to reinsurers licensed and domiciled in the United States. (d) A qualified jurisdiction shall agree to share information and cooperate with the superintendent with respect to all certified reinsurers domiciled within that jurisdiction. (e) A jurisdiction shall not be recognized as a qualified ju...

...ental health and substance use disorder benefits for possible parity violations; (3) Adopt rules in accordance with Chapter 119. of the Revised Code as necessary to do both of the following: (a) Effectuate any provisions of the Mental Health Parity and Addiction Equity Act that relate to the business of insurance; (b) Enforce, monitor compliance with, and ensure continued compliance with this section. (D) Not...

...r life, health, or disability insurance benefits or a civil or criminal proceeding involving an individual, and that is collected in connection with, or in reasonable anticipation of, a claim for life, health, or disability insurance benefits or civil or criminal proceeding involving an individual. However, information otherwise meeting the requirements of this division shall nevertheless be considered personal infor...

...ment, or a request for change in policy benefits, thirty months from the date the authorization is signed; (2) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (a) The term of coverage of the policy if the claim is for a health insurance benefit; (b) The duration of the claim if the claim is not for a health insurance ...

...ance coverage on human lives, including benefits of endowment and annuities, and may include benefits in the event of death or dismemberment by accident and benefits for disability income; (2) Accident and health, which is insurance coverage for sickness, bodily injury, or accidental death, and may include benefits for disability income; (3) Property, which is insurance coverage for the direct or consequential lo...

...d to enforce all rights and collect all benefits to which it is entitled pursuant to the policy. (2) With respect to any policy of life insurance delivered or issued for delivery in this state before the effective date of this amendment and in which any institution or entity described in division (B)(1) of this section has been designated owner of or beneficiary, the institution or entity has an insurable interest i...

... with respect to provisions relative to benefits in the event of total and permanent disability and provisions which grant additional insurance specifically against death by accident or by accidental means; (D) A provision that all statements made by the insured in the application shall, in the absence of fraud, be deemed representations and not warranties; (E) A provision that if the age of the insured has been ...

...e made in premiums, dividends, or other benefits under the policy. (C) The rate of interest charged on a policy loan made under division (B)(2) of this section shall not exceed the higher of the following: (1) The published monthly average for the calendar month ending two months before the date on which the rate is determined; (2) The rate used to compute the cash surrender values under the policy during the appl...

...ative form of government, and providing benefits in accordance with this chapter, is hereby declared to be a fraternal benefit society.

...(A) A fraternal benefit society may create, maintain, and operate charitable, benevolent, or educational institutions for the benefit of its members and their families and dependents and for the benefit of children insured by the society. For such purpose it may own, hold, or lease personal property or real property located within or without this state, with necessary buildings. The property shall be reported in ever...

...surers issuing policies containing like benefits based upon such tables.

...hospital, surgical, and medical expense benefits or hospital confinement indemnity benefits, and that is delivered or issued for delivery in this state on or after January 1, 1981, shall provide covered family members the right to continue such coverage upon the death of the named insured and upon the divorce, the annulment or dissolution of marriage, or the legal separation of the spouse from the named insured. Such...

...this state that excludes or reduces the benefits payable to or on behalf of an insured because benefits are also payable or have been paid under a supplemental sickness and accident policy 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 ...

...tion of coverage shall provide the same benefits as those provided to any similarly situated eligible person who is covered under the same group policy and an employee who has not been called or ordered to active duty. (2) An employer shall notify each employee of the right of continuation of coverage at the time of employment. At the time the reservist is called or ordered to active duty, the employer shall notify ...

...condition for which the insured sought benefits. (3) After a policy or certificate has been in force for at least two years, 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 knowingly and intentionally misrepresented relevant facts relating to the insured's health in the insured's ap...

...ent insurance; or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance. (b) Coverage provided under the medicaid program. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent t...

...ent insurance policies providing dental benefits, and that bases payment for those benefits on a usual and customary fee charged by dentists, and each administrator of a self-insured dental plan that bases payment for dental benefits on a usual and customary fee charged by dentists, shall disclose all of the following in accordance with division (B) of this section: (1) The frequency of the determination of the usua...

...(A) If a person is covered by a health benefit plan issued by a sickness and accident insurer, health insuring corporation, or multiple employer welfare arrangement and the person is required to pay for health care costs out-of-pocket or with funds from a savings account, the amount the person is required to pay to a health care provider or pharmacy shall not exceed the amount the sickness and accident insurer, healt...

...(A) As used in this section, "health benefit plan" has 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 ...

... substantially all medical and surgical benefits under the policy. (B) Benefits provided under this section shall cover, at minimum, all of the following: (1) For speech and language therapy or occupational therapy for an insured under the age of fourteen that is performed by a licensed therapist, twenty visits per year for each service; (2) For clinical therapeutic intervention for an insured under the age of ...

...-existing condition exclusion; (4) The benefits and premiums available under all health benefit plans for which the employer is qualified. (B) The information described in division (A) of this section shall be provided in a manner determined to be understandable by the average small employer, and in a manner sufficient to reasonably inform a small employer regarding the employer's rights and obligations under the h...