Ohio Revised Code Search

...ed service area. (2) The individual's place of employment is located in the approved service area. (B) Contract with providers and health care facilities for the health care services to which enrollees are entitled under the terms of the health insuring corporation's health care contracts; (C) Contract with insurance companies authorized to do business in this state for insurance, indemnity, or reimbursement again...

...onsible for such funds in a fiduciary relationship to the corporation.

...ot apply to an insurer licensed and regulated pursuant to Title XXXIX of the Revised Code except with respect to its health insuring corporation activities authorized and regulated pursuant to this chapter. (B) For the purpose of clarifying jurisdiction under the "Bankruptcy Reform Act of 1978," 92 Stat. 2549, 11 U.S.C.A. 101, and in recognition of the right of this state to regulate domestic insurance companies und...

...idence of coverage for the health care plan under which health care benefits are provided. (B) Every subscriber of a health insuring corporation that offers basic health care services is entitled to an identification card or similar document that specifies the health insuring corporation's name as stated in its articles of incorporation, and any trade or fictitious names used by the health insuring corporation. Th...

...ssion and routing of prescription drug claims pursuant to a policy, contract, or agreement for health care services; (b) A person or entity that a health insuring corporation contracts with to issue a standardized identification card or an electronic technology described in division (A)(1)(a) of this section. (2) Notwithstanding division (A)(1) of this section, this section does not apply to the issuance or r...

... Revenue Code of 1986," 100 Stat. 2085, lass='keyword-hit'>lass='keyword-hit'>26 U.S.C. 223, as amended.

... benefit payment under a closed panel plan to a physician or health care facility with which the health insuring corporation does not have a contract, provided that none of the bases set forth in that division are used as a reason for failing to make a benefit payment. (2) When a health insuring corporation is unable to provide a covered health care service from a contracted provider or health care facility, ...

...mployer that offers any health benefit plan under which the child is eligible for coverage. (d) The child is not eligible for coverage under the medicaid program or the medicare program. (2) That attainment of the limiting age for dependent children shall not operate to terminate the coverage of a dependent child if the child is and continues to be both of the following: (a) Incapable of self-sustaining empl...

...A health insuring corporation shall provide coverage, in accordance with the terms of the contract, for a subscriber's dependent children living outside the health insuring corporation's approved service area if a court order requires the subscriber to provide health care coverage to the dependent children.

...enrollee because of any health status-related factor in relation to the subscriber or enrollee, the subscriber's or enrollee's requirements for health care services, or for any other reason designated under rules adopted by the superintendent of insurance. (2) Unless otherwise required by state or federal law, no health insuring corporation, or health care facility or provider through which the health insuring corp...

...tion shall establish and maintain a complaint system that has been approved by the superintendent of insurance to provide adequate and reasonable procedures for the expeditious resolution of written complaints initiated by subscribers or enrollees concerning any matter relating to services provided, directly or indirectly, by the health insuring corporation, including, but not limited to, complaints regarding cancell...

...all use a name that is deceptively similar to the name or description of any insurance or surety corporation doing business in this state. (C) All solicitation documents, advertisements, evidences of coverage, and enrollee identification cards used by a health insuring corporation shall contain the health insuring corporation's name. The use of a trade name, an insurance group designation, the name of a parent...

...ocuments, testimony, or other records relating to any matter that is the subject of evaluation or review by the peer review committees, if consent is provided by the health care facility and any physician or other provider whose professional qualifications or activities are the subject of evaluation or review. (B) Any immunity from liability for damages that is provided under section 2305.251 of the Revised Code an...

...missible investments under section 1751.lass='keyword-hit'>lass='keyword-hit'>26 or 3925.08 of the Revised Code. (B) A health insuring corporation may seek permission from the superintendent of insurance to invest funds under Chapter 3906. of the Revised Code and may invest funds under that chapter if such permission is granted.

...(A) For purposes of this section, real estate used for "the accommodation of the health insuring corporation's business operations" includes the health insuring corporation's home office, branch office, medical facilities, and field office operations. (B) No health insuring corporation shall purchase, hold, or convey real estate, or any interest in real estate, to be used as an investment for the production of incom...

...less than two hundred fifty thousand dollars. (2) Each health insuring corporation authorized to provide only supplemental health care services shall maintain a deposit of not less than one hundred fifty thousand dollars. (3) Each health insuring corporation authorized to provide only specialty health care services shall maintain a deposit of not less than seventy-five thousand dollars. (4) Each health insuring co...

... bond in the amount of three million dollars as security to fulfill the obligations of the health insuring corporation to pay claims of contracted providers for covered health care services provided to medicaid recipients. The bond shall be payable to the department of insurance in the event that the health insuring corporation is placed in rehabilitation or liquidation proceedings under Chapter 3903. of the Re...

...han one million two hundred thousand dollars. (2) Every health insuring corporation authorized to provide only supplemental health care services shall maintain total admitted assets equal to at least one hundred ten per cent of the liabilities of the corporation. However, at no time shall the corporation's net worth be less than five hundred thousand dollars. (3) Every health insuring corporation authorized to prov...

... of the health care services to be available and the approximate number and type of full-time equivalent medical practitioners. The information shall be presented in the solicitation document in a manner that is clear, concise, and intelligible to prospective applicants in the proposed service area. (C) Every potential applicant whose subscription to a health care plan is solicited shall receive, at or before ...

...h insuring corporation, including its balance sheet and receipts and disbursements for the preceding year, which reflect, at a minimum: (1) All premium rate and other payments received for health care services rendered; (2) Expenditures with respect to all categories of providers, facilities, insurance companies, and other persons engaged to fulfill obligations of the health insuring corporation arising out of it...

...Each health insuring corporation, annually, on or before the first day of June, shall file with the superintendent of insurance an audit report certified by an independent certified public accountant covering the preceding calendar year. The report shall be verified by an officer of the health insuring corporation and shall be in the form prescribed by the superintendent by rule.

...its most recent provider list, its complaint procedure established pursuant to section 1751.19 of the Revised Code, and a description of its utilization review, internal review, and external review processes established under sections 1751.77 to 1751.83 and Chapter 3922. of the Revised Code. A health insuring corporation may satisfy this requirement by delivering to its subscribers a document that identifies a...

...(A) Each health insuring corporation and each applicant for a certificate of authority under this chapter shall be subject to examination by the superintendent of insurance in accordance with section 3901.07 of the Revised Code. Section 3901.07 of the Revised Code shall govern every aspect of the examination, including the circumstances under and frequency with which it is conducted, the authority of the superintende...

...les of incorporation, its health care plan or plans, or in a manner contrary to that described in and reasonably inferred from any other information submitted under section 1751.03 of the Revised Code, unless amendments to such submissions have been filed and have taken effect in compliance with this chapter. (2) The health insuring corporation fails to issue evidences of coverage in compliance with the requir...

... take such action as in accordance with law and the evidence. The action shall be set out in written findings which shall be mailed to the applicant or health insuring corporation. The action of the superintendent is subject to review in accordance with Chapter 119. of the Revised Code. (C) Chapter 119. of the Revised Code applies to proceedings under this section to the extent that it is not in conflict with ...