Ohio Revised Code Search

...sed Code, the superintendent shall give consideration to the inclusion in the rule of the definition of "insurance rating agency" found in section 1.65 of the Revised Code.

... all of the following shall not be considered insurance and nothing in Title XXXIX or Chapter 1739., 1751., or 1753. of the Revised Code shall apply to such an agreement: (A) It is in writing. (B) It is between a patient, or that patient's legal representative, and a health care provider and is related to services to be provided in exchange for the payment of a fee to be paid on a periodic basis. (C) It allows ...

...n 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) Healthcare benefit coverage provided by a nonprofit agricultural membership organization that meets all o...

...olates section 3901.09 of the Revised 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 tha...

...n in the development of policy forms or content, or to lead to the standardization of policy forms or content.

...icy" 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 3902.01 to 3902.08 of the Revised Code; any cer...

...y in this state. (3) Any group annuity contract that serves as a funding vehicle for pension, profit-sharing, or deferred compensation plans; (4) Any form used in connection with, as a conversion from, as an addition to, or in exchange pursuant to a contractual provision for, a policy delivered or issued for delivery on a form approved, or permitted to be issued prior to the dates such forms must be approved pursua...

... to any endorsements or riders; (4) It contains a table of contents or an index of the principal sections of the policy, if the policy has more than three thousand words printed on three or fewer pages of text, or if the policy has more than three pages regardless of the number of words. (B) For the purposes of this section, a Flesch reading ease test score shall be measured by the following method: (1) For policy...

...to 3902.08 of the Revised Code shall be construed to negate any law of this state permitting the issuance of any policy form after it has been on file for the time period specified.

... lower score meets any of the following conditions: (A) The lower score will provide a more accurate 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.

...ions 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.

...ed not be refiled for approval, but may continue to be lawfully delivered or issued for delivery in this state upon the filing with the superintendent of a list of such forms identified by form number and accompanied by a certificate as to each such form in the manner provided in division (D) of section 3902.04 of the Revised Code. (B) The superintendent may, in the superintendent's discretion, extend the dates in ...

...ans 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 other ind...

...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.

...vers the person as a dependent is the secondary plan. (3) When more than one plan covers the same child as a dependent of different parents who are not divorced or separated, the primary plan is the plan of the parent whose birthday falls earlier in the year. The secondary plan is the plan of the parent whose birthday falls later in the year. If both parents have the same birthday, the benefits of the plan that cove...

...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.

...s 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.

...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 superintendent may prescribe a separate claim form for each third-party payer. If a national standard claim form is established by the sickness and accident...

...ndred 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.

...ion (B)(3) of this section shall not be construed to require a specific reimbursement amount. (C) A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telehealth services other than such a benefit maximum imposed on all benefits offered under the plan. (D)(1) A health benefit plan shall not impose a cost-sharing requirement for telehealth services that exceeds the cost-sha...

...n (C) of this section, a provision in a contract entered into between a third-party payer 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...

...health plan issuers; (2) Evaluate all consumer and provider complaints regarding mental 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, m...

... determine whether an emergency medical condition exists; (2) Treatment necessary to stabilize an emergency medical condition; (3) Appropriate transfers undertaken prior to an emergency medical condition 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. ...

...linical laboratory services provided in connection with care described in division (A)(1) of this section, a health plan issuer shall reimburse any out-of-network provider and any out-of-network facility that provided the clinical 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 ...

...f the Revised Code has not successfully concluded within thirty days, or if both parties agree that they are at an impasse, the provider, facility, emergency facility, or ambulance may send a request for arbitration to the superintendent of insurance and shall notify the health plan issuer of its request. To be eligible for arbitration, both of the following must apply: (a) The service in question was provided not ...