Ohio Revised Code Search

...or authorization requirement" means any practice implemented by a health plan issuer in which coverage of a health care service, device, or drug is dependent upon a covered person or a provider obtaining approval from the health plan issuer prior to the service, device, or drug being performed, received, or prescribed, as applicable. "Prior authorization requirement" includes prospective or utilization review procedu...

...B of Title XVIII of the Social Security Act, 42 U.S.C. 1395, as amended, for the service in question, excluding any in-network cost sharing imposed under the health benefit plan. (2) In lieu of accepting reimbursement under division (B)(1) of this section, a provider, facility, emergency facility, or ambulance may notify the health plan issuer that the provider, facility, emergency facility, or ambulance wishes to ...

... in this section, "provider" includes a practice of providers to the extent permitted by rules adopted by the superintendent of insurance under division (D) of section 3902.54 of the Revised Code including but not limited to rules adopted regarding the maximum number of providers in a practice.

...mbulance, 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 dispute; (e) The covered person who received the service that is the subject of a dispute or the covered person's immediate family. (2) The superintendent shall require the arbitration entity to do all of the followi...

...d, 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 to nearby tissues, lymph nodes, or other areas or parts of the body.

...biologics compendium. (2) The best practices for the treatment of stage four advanced metastatic cancer, as supported by peer-reviewed medical literature. (C) A violation of this section is an unfair and 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...

...l be considered an unfair and deceptive practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.

...ogist" 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 section 3901.71 of the Revised Code, a health benefit plan shall provide coverage for the full cost of both of the following: (1) One...

...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.

...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 medicaid services, measure...

...rt programs whether sponsored by a manufacturer, foundation, or other entity. (2) Except as may be required by law, interfere with, prevent, or materially discourage access, exchange, or use of the data required under division (B) of this section, including any of the following: (a) Charging fees; (b) Not responding to a request at the time the request is made, if such a response is reasonably possible; (c) I...

...ation in connection with insurance transactions that pertains to natural persons who are residents of this state; (2) Engage in insurance transactions with applicants, individuals, or policyholders who are residents of this state. (B) The rights granted by sections 3904.01 to 3904.22 of the Revised Code extend to both of the following persons who are residents of this state: (1) Natural persons who are the subject...

...on in connection with an insurance transaction. However, a pretext interview may be undertaken to obtain information from a person or institution that does not have a generally or statutorily recognized privileged relationship with the person about whom the information relates for the purpose of investigating a claim where, based upon specific information available for review by the superintendent of insurance, there...

...al in connection with an insurance transaction.

... form in connection with insurance transactions a form or statement that authorizes the disclosure of personal or privileged information about an individual to the insurance institution, agent, or insurance support organization, unless the form or statement: (A) Is written in plain language; (B) Is dated; (C) Specifies the types of persons authorized to disclose information about the individual; (D) Specifies the...

...al in connection with an insurance transaction involving an application for insurance, a policy renewal, a policy reinstatement, or a change in insurance benefits unless the insurance institution or agent informs the individual that he may request to be interviewed in connection with the preparation of the investigative consumer report, and that upon a request under section 3904.08 of the Revised Code, he is entitled...

...ance institution or agent authorized to act on its behalf. With respect to the copying and disclosure of recorded personal information pursuant to a request under division (A) of this section, an insurance institution, agent, or insurance support organization may make arrangements with an insurance support organization or a consumer reporting agency to copy and disclose recorded personal information on its behalf. ...

... furnish the correction, amendment, or fact of deletion to all of the following: (1) Any person specifically designated by the individual that may have, within the preceding two years, received such recorded personal information; (2) Any insurance support organization whose primary source of personal information is insurance institutions if the insurance support organization has systematically received such recorde...

...ed for coverage has engaged in criminal activity, fraud, material misrepresentation, or material nondisclosure; (b) Specific items of medical record information supplied by a medical care institution or medical professional shall be disclosed either directly to the individual about whom the information relates or to a medical professional designated by the individual and licensed to provide medical care with respect...

...on in connection with an insurance transaction concerning any previous adverse underwriting decision experienced by an individual, unless such inquiry also requests the reasons for any previous adverse underwriting decision.

...n either of the following: (A) On the fact of a previous adverse underwriting decision. However, an insurance institution or agent may base an adverse underwriting decision on further information obtained from an insurance institution or agent responsible for a previous adverse underwriting decision. (B) On personal information received from an insurance support organization whose primary source of information is i...

...ed in connection with an insurance transaction, unless the disclosure is made pursuant to any of the following: (A) With the written authorization of the individual, provided: (1) If such authorization is submitted by another insurance institution, agent, or insurance support organization, the authorization meets the requirements of section 3904.06 of the Revised Code; (2) If such authorization is submitted by ...

...(A) No person shall knowingly obtain information under false pretenses about an individual from an insurance institution, agent, or insurance support organization. (B) Whoever violates division (A) of this section is guilty of a felony of the fourth degree.

...of every insurance support organization acting on behalf of an insurance institution or agent that either transacts business in this state or transacts business outside this state that has an effect on a person residing in this state to determine whether such insurance support organization has been or is engaged in any conduct in violation of sections 3904.01 to 3904.22 of the Revised Code.