Ohio Revised Code Search

...of the Revised Code. (D) The superintendent of insurance may adopt rules as necessary to carry out the requirements of this section.

...e a penalty or demand to recoup money from the pharmacy in any amount. (D) "Dangerous drug," "pharmacy," "practice of pharmacy," and "prescription" have the same meanings as in section 4729.01 of the Revised Code. (E) "Payer" means any of the following that pays for or processes a claim for payment for the provision of dangerous drugs or pharmacy services: (1) A health insuring corporation, as defined in section 1...

...and the range of prescription numbers from which the auditing entity will select pharmacy records to audit. Notice of the date or dates on which the audit will be performed shall be given not less than ten business days before the date the audit is to commence. Notice of the range of prescription numbers from which the auditing entity will select pharmacy records to audit shall be received by the pharmacy not less th...

...il, or electronic means, as long as the time period for resubmissions established by the relevant payer has not expired.

...ion and may request an extension of the time period given. The auditing entity shall grant a request for an extension if it is reasonable. A pharmacy's submission of documentation to appeal the finding shall be made in accordance with the procedure the auditing entity has established under section 3901.814 of the Revised Code. (4)(a) An auditing entity shall deliver a final audit report to the pharmacy that was the...

...Each auditing entity in this state shall establish in writing separate procedures for a pharmacy to appeal one or more findings in a preliminary audit report issued under section 3901.813 of the Revised Code.

...sed Code shall not apply to an auditing entity that is a medicaid managed care organization if application of those sections to the entity would be in violation of federal law.

...The "Restatement of the Law, Liability Insurance" that was approved at the 2018 annual meeting of the American law institute does not constitute the public policy of this state and is not an appropriate subject of notice.

... means a systematically developed statement to assist health care provider and patient decisions with regard to appropriate health care for specific clinical circumstances and conditions. (B) "Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols, and clinical practice guidelines used by a health plan issuer or utilization review organization to determine whether o...

...a utilization review organization implements a step therapy protocol, that protocol shall be implemented via clinical review criteria that are based on clinical practice guidelines or medical or scientific evidence. (B) When establishing a step therapy protocol, a health plan issuer and a utilization review organization shall also take into account the needs of atypical patient populations and diagnoses when establ...

... site or provider portal. (4) From the time a step therapy exemption request is received by a health plan issuer or utilization review organization, the issuer or organization shall either grant or deny the request within the following time frames: (a) Forty-eight hours for a request related to urgent care services; (b) Ten calendar days for all other requests. (5)(a) A provider may, on behalf of the covered indi...

...The superintendent of insurance may adopt rules as necessary to enforce sections 3901.83 to 3901.833 of the Revised Code.

...ligations or prohibitions on insurance companies of this state doing business in that state, district, territory, or nation, or upon their agents therein, the same obligations and prohibitions shall be imposed upon insurance companies of the other state, district, or nation doing business in this state and upon their agents. When the laws of any other state, district, territory, or nation impose a requirement for ...

... as defined in section 1301 of the "Patient Protection and Affordable Care Act," 42 U.S.C. 18021, offered in this state through an exchange created under that act.

... subject to the "Employee Retirement Income Security Act of 1974," 29 U.S.C. 1001, et seq. This study shall be delivered electronically to the governor, the senate president, and the speaker of the house not later than two years after the effective date of this section .

... that discloses data or information in compliance with division (B) of this section may condition any such disclosure upon the execution of an agreement with the policyholder absolving the health plan issuer from civil liability related to the use of such data or information. (D) A health plan issuer that provides data or information in compliance with division (B) of this section shall be immune from civil liabili...

...es insurance parity and establish and promote a consumer hotline to collect information and help consumers understand and access their insurance benefits. The department of insurance and the department of behavioral health shall jointly report annually on the department's efforts, which shall include information on consumer and payer outreach activities and identification of trends and barriers to access and covera...

...When the superintendent of insurance adopts or amends a rule, including a rule related to the superintendent's duties and powers under Chapters 1751. and 1753. and Title XXXIX of the Revised Code or a rule related to an "insurance rating agency" as defined by section 1.65 of the Revised Code, the superintendent shall give consideration to the inclusion in the rule of the definition of "insurance rating agency" found ...

... (D) It requires termination to be accomplished through written notification. (E) It permits termination to take effect immediately upon the other party's receipt of the notification or not more than sixty days after the other party's receipt of the notification. (F) It does not impose a termination penalty or require payment of a termination fee. (G) It describes the health care services to be provided under...

...) The organization provides healthcare benefit coverage exclusively to members of the organization and the members' families pursuant to contracts between the members and the organization or its affiliate. (2) "Material marketing" means the official written materials and verbal communications provided to, or directed at, prospective members and members' families for advertising or marketing purposes. (B) Healthca...

...sed Code shall be fined not less than twenty-five nor more than five hundred dollars. (B) Whoever violates any law relating to the superintendent of insurance, or any law of this state relating to insurance as defined in division (A)(1) of section 3901.04 of the Revised Code, for the violation of which no penalty is otherwise provided in the Revised Code, shall be fined not more than twenty-five thousand dollars, im...

... licensing, as amended by the NAIC from time to time. (W) "Uniform business entity application" means the NAIC uniform business entity application for resident and nonresident business entities, as amended by the NAIC from time to time. (X) "Exchange" means a health benefit exchange established by the state government of Ohio or an exchange established by the United States department of health and human services in...

...e in this state unless the person is licensed for that line of authority in accordance with this chapter.

...d in that state; (8) Any salaried full-time employee who counsels or advises the employee's employer with respect to the insurance interests of the employer or of the employer's subsidiaries or business affiliates, if the employee does not sell or solicit insurance or receive a commission; (9) Any employee of an insurer or of an insurance agent who, at the direction of the insurer or agent, performs any of the foll...

...'s or associate's degree in insurance from an accredited institution. (b) The individual has earned a professional designation approved by the superintendent. (c) The individual has completed, for each line of authority for which the individual has applied, twenty hours of study in a program of insurance education approved by the superintendent, under criteria established by the superintendent, which may include ...