Ohio Revised Code Search

...The superintendent of insurance may authorize a lower score than the Flesch reading ease score required in division (A)(1) of section 3902.04 of the Revised Code whenever, in his discretion, he finds that a 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 ...

...A policy form meeting the requirements of section 3902.04 of the Revised Code shall be approved notwithstanding the provisions 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.

...nless approved by the superintendent of insurance, or permitted to be issued, pursuant to sections 3902.01 to 3902.08 of the Revised Code. Any policy form that has been approved or permitted to be issued prior to January 9, 1985, and that meets the standards set by sections 3902.01 to 3902.08 of the Revised Code need not be refiled for approval, but may continue to be lawfully delivered or issued for delivery in this...

...dividual 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 individual or group policy or agreement under which a third-party payer provides for hospital, dental, surgical, or medical...

...When a plan of health coverage is primary, its benefits are paid without regard to the benefits of another plan. When a plan of health 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.

...have engaged in an unfair and deceptive insurance act or practice under sections 3901.19 to 3901.26 of the Revised Code, and is subject to proceedings pursuant to those sections.

...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.

...As used in sections 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.

...The superintendent of insurance shall develop a standard claim form to be used by all third-party payers and providers for reimbursement of health 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 superinte...

...Beginning one hundred 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.

...fit 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-sharing requirement for comparable in-person health care services. (2)(a) A health benefit plan shall not impose a...

...(A) As used in this section: (1) "Pay in full" means paying for a health service in its entirety without cost-sharing on the part of a third-party payer. "Pay in full" includes payment made under a deductible requirement. (2) "Third-party payer" and "provider" have the same meanings as in section 3901.38 of the Revised Code. (B)(1) Subject to division (C) of this section, a provision in a contract entered into ...

...l guidance. (C) The superintendent of insurance shall implement and enforce all applicable provisions of the Mental Health Parity and Addiction 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 acc...

...efit plan according to any copayment, coinsurance, deductible, or other out-of-pocket expense requirement. (D) "Covered" or "coverage" means the provision of benefits related to health care services to a covered person in accordance with a health benefit plan. (E) "Covered person," "health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section 3922.01 of the Revised C...

...time specified by the superintendent of insurance in rule, the provider, facility, emergency facility, or ambulance shall either notify the health plan issuer of its acceptance of the reimbursement or seek to negotiate reimbursement under division (B)(2) of this section. Failure to timely notify the issuer of an intent to negotiate shall be considered acceptance of the issuer's reimbursement. (B)(1) Unless the prov...

...or 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 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 provid...

...n decision. (2) The superintendent of insurance may adopt rules pursuant to division (D) of section 3902.54 of the Revised Code specifying situations in which sections 3901.38 to 3901.3814 of the Revised Code apply during periods of negotiation under section 3902.51 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 ...

...(A)(1) 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...

...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...

...d 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...

...d deceptive practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.

...(A) As used in this section: (1) "Hearing aid" means any wearable instrument or device designed or offered for the purpose of aiding or compensating for impaired human hearing, including all attachments, accessories, and parts thereof, except batteries and cords, that is dispensed by a licensed audiologist, a licensed hearing aid dealer or fitter, or an otolaryngologist. (2) "Otolaryngologist" means a licensed ph...

...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.

...(A) On and after the 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 medic...