Ohio Revised Code Search

...(A) The purpose of sections 3902.01 to 3902.08 of the Revised Code is to establish minimum standards for language used in policies and certificates of life insurance and annuities, credit life insurance and credit disability insurance, and sickness and accident insurance, and subscriber policies or certificates of health insuring corporations, delivered or issued for delivery in this state, to facilitate ease of read...

...1 to 3902.08 of the Revised Code: (A) "Policy" or "policy form" means any policy, contract, plan or agreement of life insurance and annuities, credit life insurance and credit disability insurance, and sickness and accident insurance, and subscriber policies, contracts, certificates, and agreements of health insuring corporations, delivered or issued for delivery in this state by any company subject to sections 3902...

...902.08 of the Revised Code apply to all policies delivered or issued for delivery in this state by any company on or after the date such forms must be approved under sections 3902.01 to 3902.08 of the Revised Code. Sections 3902.01 to 3902.08 of the Revised Code do not apply to: (1) Any policy that is a security subject to federal jurisdiction; (2) Any group policy, other than a group credit life insurance policy, ...

...(A) No policy forms, except as stated in section 3902.03 of the Revised Code, shall be delivered or issued for delivery in this state on or after the dates such forms 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 sect...

...is state permitting the issuance of any policy form after it has been on file for the time period specified.

...rate 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 certain policy language that is drafted to conform to the requirements of any law, rule, or agency interpretation.

...A policy form meeting the requirements of section 3902.04 of the Revised Code shall be approved notwithstanding the provisions of any other laws that specify the content of policies, if the policy form provides the policyholders and claimants protection not less favorable than they would be entitled to under such laws.

...902.08 of the Revised Code apply to all policy forms filed on or after January 9, 1983. No policy form shall be delivered or issued for delivery in this state on or after January 9, 1985 unless approved by the superintendent of insurance, or permitted to be issued, pursuant to sections 3902.01 to 3902.08 of the Revised Code. Any policy form that has been approved or permitted to be issued prior to January 9, 1985, an...

...rage" 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, 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 o...

...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.

...practice under sections 3901.19 to 3901.26 of the Revised Code, and is subject to proceedings pursuant to those sections.

...d 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.

...oinsurance, 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 professional" has the same meaning as in section 4743.09 of the Revised Code. (4) "In-person health care services" means health care services delivered by a health c...

...d 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 provision in a ...

...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) Nothing in this ...

...oinsurance, deductible, or other out-of-pocket expense requirement. (D) "Covered" or "coverage" means the provision of benefits related to health care services to a covered person in accordance with a health benefit plan. (E) "Covered person," "health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code. (F) "Drug" has the same meaning ...

...nical laboratory services. (3) For purposes of sections 3902.50 to 3902.54 of the Revised Code: (a) In the request for reimbursement, the provider, facility, emergency facility, or ambulance shall include the proper billing code for the service for which reimbursement is requested. (b) The health plan issuer shall send the provider, facility, emergency facility, or ambulance its intended reimbursement as descr...

... reimbursement rates previously agreed upon between the issuer and the provider, facility, emergency facility, or ambulance; (4) The results of, or any documents submitted in the course of, a previous arbitration between the parties conducted under this section that the arbitrator considers relevant in rendering a decision. (D) After considering the evidence submitted by the parties pursuant to division (B) of t...

...nsurance 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.

...tion; (c) Utilize a secure electronic portal for the submission, processing, and management of arbitration applications; (d) Perform all arbitrations under section 3902.52 of the Revised Code on a flat fee basis. (B) In selecting the arbitration entity with which to contract, the superintendent shall at minimum require a prospective arbitration entity to submit to the superintendent a disclosure containing all ...

...As used in sections 3902.60 and 3902.61 of the Revised Code: (A) "Associated conditions" means the symptoms or side effects of stage four advanced metastatic cancer, or the treatment thereof, which would, 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 p...

...nsurance under sections 3901.19 to 3901.26 of the Revised Code.