Ohio Revised Code Search

...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 an unfair and deceptive act or practice in the business of insurance 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...

...) 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 fina...

... 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 primary or original site of the cancer t...

...ibed to treat such cancer or associated conditions dependent upon a covered person demonstrating either of the following: (1) Failure to successfully respond to a different drug; (2) A history of failing to respond to a different drug or drugs. (B) Division (A) of this section applies only to uses of such drug or drugs that are consistent with either of the following: (1) An indication approved by, or descri...

... 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 accordance with section 4729.281 of the Revised Code. A health benefit plan shall not impose cost-sharing req...

...ns, as well as all related limitations, conditions, and exclusions. (C) A violation of this section shall be considered an unfair and deceptive practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.

... (B) Nothing in this section shall be construed as prohibiting a health benefit plan from establishing variable reimbursement rates based on quality or performance measures.

...y this section without any financial or contractual penalty to the covered person or to the provider of the hearing aid. (D) A health plan issuer is not required to pay a claim for the cost of a hearing aid as required by division (B) of this section if, less than forty-eight months prior to the date of the claim, the covered person received the coverage required under division (B) of this section from any health b...

...b(a)(4) and includes any pharmacy under contract with the entity to dispense drugs on behalf of the entity. (B) "Terminal distributor of dangerous drugs" has the same meaning as in section 4729.01 of the Revised Code. (C) "Third-party administrator" has the same meaning as in section 5167.01 of the Revised Code.

... acquisition cost rate for that drug as determined by the United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition cost of the drug, as defined in 42 U.S.C. 1395w-3a(c)(6)(B); (2) A dispensing fee reimbursement amount that is less than the reimb...

... section shall use established industry content and transport standards published by either of the following: (1) A standards developing organization accredited by the American national standards institute, including the national council for prescription drug programs, ASC X12, health level 7; (2) A relevant federal or state governing body, including the centers for medicare and medicaid services or the office of...

...olicy pursuant to a viatical settlement contract. (B) "Business of viatical settlements" means an activity involved, but not limited to, in the offering, solicitation, negotiation, procurement, effectuation, purchasing, investing, financing, monitoring, tracking, underwriting, selling, transferring, assigning, pledging, or hypothecating or in any other manner acquiring an interest in a policy by means of viatical ...

...erent states, the viatical settlement contract shall be governed by the law of the state in which the owner having the largest percentage ownership of the policy resides or, if the owners hold equal ownership, the state of residence of one owner agreed upon in writing by all owners. (2) If the viator is a resident of this state, all agreements to be signed by the viator shall provide exclusive jur...

...surety bonds in this state; (ii) An unconditional and irrevocable letter of credit, deposit of cash, or securities, in any combination, in the aggregate amount of two hundred fifty thousand dollars. (2) The superintendent may request proof of financial responsibility at any time the superintendent considers necessary. (E) An applicant shall provide all information requested by the superintendent. The superinten...

...ent broker shall maintain at least one designated individual who is individually licensed as a viatical settlement broker to be responsible for the licensee's compliance with this chapter.

...nsated, a viatical settlement broker is deemed to represent only the viator and owes a fiduciary duty to the viator to act according to the viator's instructions and in the best interest of the viator.

...atical settlement contract form or provide a disclosure statement form to a viator in this state unless the viatical settlement contract form or the disclosure statement form is filed with and approved by the superintendent of insurance. The superintendent shall disapprove a viatical settlement contract form or a disclosure statement form if, in the superintendent's opinion, the viatical settlement contract form, the...

...pplication for the viatical settlement contract: (a) That there are possible alternatives to viatical settlement contracts, including any accelerated death benefits offered under the viator's policy; (b) That some or all of the proceeds of the viatical settlement may be subject to federal income taxation and state franchise and income taxation, and that assistance should be sought from a professional tax adv...

...der entering into a viatical settlement contract shall first obtain all of the following: (1) If the viator is the insured, a written statement from an attending physician, certified nurse-midwife, clinical nurse specialist, or certified nurse practitioner that the viator is of sound mind and under no constraint or undue influence to enter into a viatical settlement contract. As used in this division, "physician" ...

...t entered into in this state shall provide the viator with an unconditional right to rescind the contract for at least fifteen calendar days after the receipt of the viatical settlement proceeds. If the insured dies during the rescission period, the viatical settlement contract is deemed to have been rescinded, subject to repayment of all viatical settlement proceeds to the viatical settlement provider. If a viatica...

...on pursuant to the viatical settlement contract and the escrow agreement. The escrow agent shall make payment within three business days of the date the escrow agent received the acknowledged forms from the insurance company. Funds are considered sent to a viator as of the date that the escrow agent either releases the funds for wire transfer to the viator or places a check for delivery to the viator...

...act with the insured for the purpose of determining the health status of the insured shall be made only by the viatical settlement provider, or the authorized representative of the viatical settlement provider. The viatical settlement provider, or authorized representative shall not contact the insured for the purpose of determining the insured's health status more than once every three months if ...

... (a) All proposed, offered, or executed contracts, purchase agreements, underwriting documents, policy forms, and applications from the date of the proposal, offer, or execution of the contract or purchase agreement, whichever is later; (b) All checks, drafts, or other evidence and documentation related to the payment, transfer, deposit, or release of funds from the date of the transaction; (c) All other records an...

...value of unsettled viatical settlement contracts that have been signed by the viator but have not been settled as of the date of the report categorized by the number of days since the viator signed the contract; (2) Number of policies purchased, total amount of settlement paid for policies purchased, total face value of policies purchased beginning with the reporting year and most recent five years; (3) Nu...

...nd insured have provided prior written consent to the disclosure. (B) The disclosure is provided in response to an investigation or examination by the superintendent of insurance or by any other governmental officer or agency or pursuant to the requirements of division (C) of section 3916.18 of the Revised Code. (C) The disclosure is a term of, or condition to, the transfer of a viaticated policy by one viatical ...