Ohio Revised Code Search

...efit 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 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 C...

...time specified by the superintendent of insurance in rule, the provider, facility, emergency facility, or ambulance shall either notify the health plan issuer of its acceptance of the reimbursement or seek to negotiate reimbursement under division (B)(2) of this section. Failure to timely notify the issuer of an intent to negotiate shall be considered acceptance of the issuer's reimbursement. (B)(1) Unless the prov...

..., or ambulance may bundle up to fifteen claims with respect to the same health benefit plan that involve the same or similar services provided under similar circumstances. Any bundled claims shall be for services using the same coding set and providers of the same license type. (b) A claim that is bundled with other claims may be seven hundred fifty dollars or less so long as the sum of the bundled claims is greate...

...n decision. (2) The superintendent of insurance may adopt rules pursuant to division (D) of section 3902.54 of the Revised Code specifying situations in which sections 3901.38 to 3901.3814 of the Revised Code apply during periods of negotiation under section 3902.51 of the Revised Code. (B) A pattern of continuous or repeated violations of section 3902.51 or 3902.52 of the Revised Code by a health plan issuer is ...

...(A)(1) The 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...

...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...

...d 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...

...d deceptive practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.

...(A) As used in this section: (1) "Hearing aid" means any wearable instrument or device designed or offered for the purpose of aiding or compensating for impaired human hearing, including all attachments, accessories, and parts thereof, except batteries and cords, that is dispensed by a licensed audiologist, a licensed hearing aid dealer or fitter, or an otolaryngologist. (2) "Otolaryngologist" means a licensed ph...

...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.

...(A) On and after the 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 medic...

...(A) As used in this section, "health care provider" has the same meaning as in section 3701.74 of the Revised Code. (B) A health plan issuer, including a pharmacy benefit manager, shall, upon request of a covered person, the covered person's health care provider, or the third-party representative, furnish the following data for any and all drugs covered under a related health benefit plan: (1) The covered person'...

...the general assembly for the payment of claims of insolvent insurers. "Foreign guaranty association" means any similar entities now in existence in or hereafter created by the legislature of any other state. (O) "Insolvency" or "insolvent" means: (1) For an insurer issuing only assessable fire insurance policies either of the following: (a) The inability to pay any obligation within thirty days after it becomes...

...he powers granted the superintendent of insurance under any other section of the Revised Code. (C) Sections 3903.01 to 3903.59 of the Revised Code shall be liberally construed to effect the purpose stated in division (D) of this section. (D) The purpose of sections 3903.01 to 3903.59 of the Revised Code is the protection of the interests of insureds, claimants, creditors, and the public generally, with minimum inte...

...usiness in this state, and against whom claims arising from that business may exist now or in the future; (B) All insurers who purport to do an insurance business in this state; (C) All insurers who have insureds resident in this state; (D) All other persons organized or in the process of organizing with the intent to do an insurance business in this state; (E) All other companies, associations, societies, or ent...

...anyone other than the superintendent of insurance of this state. No court has jurisdiction to entertain, hear, or determine any delinquency proceeding commenced by any other person. (B) No court of this state has jurisdiction to entertain, hear, or determine any complaint praying for the dissolution, liquidation, rehabilitation, sequestration, conservation, or receivership of any insurer, or praying for a temporary ...

...(A) Upon complaint or motion of any receiver, conservator, rehabilitator, or liquidator appointed in a proceeding under sections 3903.01 to 3903.59 of the Revised Code, any court of general jurisdiction may issue a temporary restraining order, a preliminary injunction, a permanent injunction, or such other orders that the court considers necessary and proper to prevent any one or more of the following: (1) The trans...

...ll cooperate with the superintendent of insurance 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" include...

...the Revised Code, the superintendent of insurance and his deputies are responsible on their official bonds for the faithful performance of their duties. If the court considers it desirable for the protection of the assets, it may at any time require an additional bond from the superintendent or his deputies, and such bonds shall be paid for out of the assets of the insurer as a cost of administration. (B) Sections ...

...Every proceeding to rehabilitate or liquidate an insurer commenced under the laws in effect before the effective date of sections 3903.01 to 3903.59 of the Revised Code shall be continued as it would have been continued had these sections not been enacted.

...(A) Whenever the superintendent of insurance has reasonable cause to believe, and determines, after a hearing held under division (E) of this section, that any domestic insurer has committed or engaged in, or is about to commit or engage in, any act, practice, or transaction that would subject it to delinquency proceedings under sections 3903.01 to 3903.59 of the Revised Code, he may make and serve upon the insurer a...

...(A) The superintendent of insurance may file in the court of common pleas a complaint alleging, with respect to a domestic insurer all of the following: (1) That there exist any grounds that would justify a court order for a formal delinquency proceeding against an insurer under sections 3903.01 to 3903.59 of the Revised Code; (2) That the interests of policyholders, creditors, or the public will be endangered by d...

... other documents, and all department of insurance files and court records and papers, so far as they pertain to or are a part of the record of the proceedings, shall be and remain confidential and privileged except as is necessary to enforce compliance with those sections, unless and until the court of common pleas, after hearing arguments from the parties in chambers, shall order otherwise, or unless the insurer req...

...The superintendent of insurance may file a complaint in the court of common pleas for an order authorizing him to rehabilitate a domestic insurer or an alien insurer domiciled in this state on any one or more of the following grounds: (A) The insurer is in such condition that the further transaction of business would be hazardous, financially, to its policyholders, creditors, or the public. (B) There is reasonable...