Ohio Revised Code Search

... 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) Division (B)(1)(b) of this section shall not be construed as prohibiting a provision in a c...

...ion Equity Act and shall do all of the following: (1) Proactively ensure compliance by 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 P...

... "Emergency services" means all of the following as described in 42 U.S.C. 1395dd: (1) Medical screening examinations undertaken to 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 s...

...d out-of-network care when both of the following apply: (i) The services are provided to a covered person at an in-network facility. (ii) The services would be covered if provided by an in-network provider. (b) A health plan issuer shall reimburse both of the following for emergency services provided to a covered person at an out-of-network emergency facility: (i) An out-of-network provider; (ii) The out-of...

... eligible for arbitration, both of the following must apply: (a) The service in question was provided not more than one year prior to the request. (b) The billed amount exceeds seven hundred fifty dollars, except as provided in division (A)(2)(b) of this section. (2)(a) In seeking arbitration, a provider, facility, emergency facility, or ambulance may bundle up to fifteen claims with respect to the same health ...

...) 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 Revised Code as applicab...

...r financial connection with any of the following: (a) The health plan issuer involved in a dispute; (b) An officer, director, or employee of the health plan issuer; (c) A provider, facility, emergency facility, ambulance, medical group, or independent practice organization involved with the service in question; (d) The development or manufacture of any principal drug, device, procedure, or other therapy in di...

...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...

...red 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 described in, as applicable, either of the following for the treatment of stag...

...(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...

... 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.

...ds, that is dispensed by a licensed audiologist, a licensed hearing aid dealer or fitter, or an otolaryngologist. (2) "Otolaryngologist" means a licensed physician who practices otolaryngology. (3) "Related services" means services necessary to assess, select, and appropriately adjust or fit a hearing aid to ensure optimal performance. (B) On and after the effective date of this section, and notwithstanding sec...

...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.

...ed 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 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...

...hird-party representative, furnish the following data for any and all drugs covered under a related health benefit plan: (1) The covered person's eligibility information for any and all covered drugs; (2) Cost-sharing information for any and all covered drugs, including a description of any variance in cost-sharing based on pharmacy, whether retail or mail order, or health care provider dispensing or administerin...

...As used in this chapter, "company" includes corporations and associations.

...915.24 of the Revised Code, industrial policies except as provided in sections 3915.07 and 3915.071 of the Revised Code, fraternal benefit societies, corporations or associations operating on the assessment plan, or corporations or associations which have been organized under sections 3919.01 to 3919.19 of the Revised Code, except corporations and associations which, as of September 28, 1933, have amended their artic...

...No policy of life insurance shall be issued or delivered in this state, and no policy of life insurance of a life insurance company organized under the laws of this state shall be issued, unless it meets the requirements of this chapter.

...Life insurance policies may provide for not more than one year preliminary term insurance by incorporation therein of the following clause immediately preceding the "change of beneficiary" clause: "The first year's insurance under this policy is term insurance." If the premium charged for term insurance under a limited payment life or endowment preliminary term policy, providing for the payment of all premiu...

...No policy of life insurance shall be issued or delivered in this state or be issued by a life insurance company organized under the laws of this state unless such policy contains: (A) A provision that all premiums shall be payable in advance, either at the home office of the company or to an agent of the company, upon delivery of a receipt signed by one or more of the officers named in the policy; (B) A provision...

...the superintendent of insurance. (2) "Policy loan" includes any loan made under a policy including any premium loan made to pay one or more premiums that were not paid to the life insurer as they fell due. (3) "Policyholder" includes the owner of the policy or the person designated to pay premiums as shown on the records of the life insurer. (4) "Policy" includes life insurance policies, certificates issued by a f...

...suant to the terms of a life insurance policy other than a credit life insurance policy. (B) The interest payable pursuant to division (A) of this section shall be computed from the date of the death of the insured to the date of the payment of the proceeds and shall be at whichever of the following rates is greater: (1) The annual short-term applicable federal rate for purposes of section 1274(d) of the Internal R...

...apply to any individual life insurance policy insuring the life of a reservist, as defined in section 3923.381 of the Revised Code, who is on active duty pursuant to an executive order of the president of the United States, an act of the congress of the United States, or section 5919.29 or 5923.21 of the Revised Code, if the life insurance policy meets both of the following conditions: (a) The policy has been in fo...

...shall be available to the owner of the policy in the event of default in premium payments after premiums have been paid for three years, and such benefit shall be a stipulated form of insurance, the net value of which shall be at least equal to the reserve at the date of default on the policy and on any dividend additions thereto, less a sum not more than two and one half per cent of the amount insured by the policy ...

...(A) In the case of policies issued before January 1, 1989, or an earlier date, not before January 1, 1983, as of which section 3915.071 of the Revised Code becomes operative for such policies, no such policy of life insurance, except as set forth in division (G) of this section, shall be issued or delivered in this state unless such policy contains in substance the following provisions or corresponding provisions whi...