Ohio Revised Code Search

...ts gaming proprietor, mobile management services provider, management services provider, and sports gaming supplier licenses, the commission shall consider all of the following factors, in addition to all other requirements for licensure specified under this chapter and in the rules of the commission: (1) The reputation, experience, and financial integrity of the applicant and any person that controls the applicant...

...e C sports gaming proprietor using self-service or clerk-operated sports gaming terminals located at the facility shall hold an appropriate and valid type C sports gaming host license issued by the Ohio casino control commission at all times. (2) The commission shall issue a type C sports gaming host license to any eligible applicant that the state lottery commission recommends. Notwithstanding any contrary provis...

...s gaming proprietors, mobile management services providers, management services providers, sports gaming suppliers, or type C sports gaming hosts in this state are legal shipments of gambling devices into this state, as long as the supplier has completed the registering, recording, and labeling of the equipment in accordance with the "Gambling Devices Act of 1962," 15 U.S.C. 1171 to 1178. (B) This state is exempt f...

...) The centers for medicare and medicaid services; (E) The United States department of defense; (F) The centers for disease control and prevention; (G) The United States department of veterans affairs; (H) The drug enforcement administration; (I) The food and drug administration; (J) Any board recognized by the national institutes of health for the purpose of evaluating the medical value of health ca...

...ecutive director of the public children services agency that has jurisdiction within the specified geographical notification area and that is located within the county served by the sheriff; (3) The superintendent of each board of education of a school district that has schools within the specified geographical notification area and that is located within the county served by the sheriff; (4) The appointing or ...

...ct for the purchase of funeral goods or services. (BB) With respect to a health care contract as defined in section 3963.01 of the Revised Code that covers vision or dental services, as defined in that section, including any of the contract terms prohibited under or failing to make the disclosures required under division (E) or (F) of section 3963.02 of the Revised Code. (CC) With respect to private passenger aut...

...nding credit or offering any product or service that is equivalent to an extension of credit, require that a customer obtain insurance from a depository institution or an affiliate of a depository institution, or from a particular insurer, agent, or other person. However, this provision does not prohibit a person from informing a customer or prospective customer that insurance is required in order to obtain a loan or...

...surer. (4) All management agreements, service contracts, tax allocations agreements, and cost-sharing arrangements; (5) Any other material transaction that the superintendent, pursuant to rules adopted in accordance with Chapter 119. of the Revised Code, determines may render the insurer's surplus as regards policyholders unreasonable in relation to the insurer's outstanding liabilities and inadequate to its fina...

...ed States secretary of health and human services pursuant to that act, sections 3901.381, 3901.384, 3901.385, 3901.389, 3901.3810, 3901.3811, 3901.3812, and 3901.3813 of the Revised Code apply to a claim submitted to a third-party payer for payment for health care services only if the claim is submitted electronically. A provider and third-party payer may enter into a contractual arrangement under which the third-par...

...laim for any amount due for health care services rendered by the provider; (2) Enter into a contractual agreement under which the timing of payments by the third-party payer is not directly related to the receipt of a claim form. The contractual arrangement may include periodic interim payment arrangements, capitation payment arrangements, or other periodic payment arrangements acceptable to the provider and the thi...

...yment of any amount due for health care services rendered by a provider to a beneficiary; (B) Refuse to process or pay within the time periods specified in section 3901.381 of the Revised Code a claim submitted by a provider on the grounds the beneficiary has not been discharged from the hospital or the treatment has not been completed, if the submitted claim covers services actually rendered and charges actually in...

...ative claim for payment for health care services before the time periods specified in section 3901.381 of the Revised Code have elapsed for the original claim submitted, the third-party payer may deny the duplicative claim. Denials of claims determined to be duplicative by the department of insurance shall not be considered by the department in a market conduct examination of a third-party payer's compliance with sec...

...eneficiary who received the health care services for which overpayment was made; (2) The date or dates the services were provided; (3) The amount of the overpayment; (4) The claim number or other pertinent numbers; (5) A detailed explanation of basis for the third-party payer's determination of overpayment; (6) The method in which payment was made, including, for tracking purposes, the date of payment and, if ap...

...r benefit payments or reimbursement for services in any hospital which is not licensed under Chapter 3722. of the Revised Code. No hospital located in this state shall charge any insurance company, health insuring corporation, federal, state, or local government agency, or person for any services rendered unless the hospital is licensed under Chapter 3722. of the Revised Code. "Hospital" as used in this section means...

...imburse any of the costs of health care services, including a vision or dental benefit plan. "Health benefit plan" does not include any of the following: (a) A plan of self-insurance; (b) Insurance arising out of workers' compensation; (c) Automobile medical payment insurance; (d) Insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in an...

...or governmental entity providing health services coverage for individuals on a self-insurance basis. (3) "Group policy" means, with respect to life insurance, a policy covering more than twenty-five individuals and issued pursuant to section 3917.01 of the Revised Code, and with respect to sickness and accident insurance, a policy covering more than twenty-five individuals and issued pursuant to section 3923.11, 39...

...f another state as a nonprofit hospital service association, corporation, or plan, that is authorized by the laws of that state to offer sickness and accident benefits for hospital services under group subscriber contracts, that has furnished certificates in connection with or pursuant to these contracts to subscribers residing or employed in this state, and that, not later than June 30, 1990, is under an order of li...

...to determine whether or not health care services or drugs are appropriate and consistent with medical or scientific evidence. (C) "Health benefit plan" and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code. (D) "Medical or scientific evidence" has the same meaning as in section 3922.01 of the Revised Code. (E) "Step therapy exemption" means an overriding of a step therapy pro...

... an average of at least thirty hours of service per week during a calendar month, or at least one hundred thirty hours of service during the calendar month. (2) "Group policyholder" means a policyholder for a health insurance policy covering fifty or more full-time employees. "Group policyholder" includes an authorized representative of a group policyholder. (3) "Health plan issuer" has the same meaning as in se...

...viders 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 superintendent may prescribe a separate claim form for each third-party payer. If a national standard claim form is estab...

...p therapy, quantity limits, and site-of-service restrictions. (C) A health plan issuer, including a pharmacy benefit manager, providing the data required under division (B) of this section shall ensure that the data meets all of the following: (1) It is current not later than one business day after any change is made. (2) It is provided in real time. (3) It is provided in the same format that the request is m...

...cted providers for covered health care services provided to medicaid recipients, then next to pay other claimants with any remaining funds, consistent with the priorities set forth in sections 3903.421 and 3903.42 of the Revised Code. (F) The rehabilitator shall have the power under sections 3903.26 and 3903.27 of the Revised Code to avoid fraudulent transfers. (G) As used in this section: (1) "Contracted pr...

...either by certified mail or by personal service at least forty days prior to the date set for hearing. If the domiciliary liquidator, within thirty days after the giving of such notice, gives notice in writing to the ancillary receiver and to the claimant, either by certified mail or by personal service, of the domiciliary liquidator's intention to contest the claim, the domiciliary liquidator shall be entitled to ap...

... amounts received for travel assistance services or cancellation fee waivers. (C) Neither of the following are insurance: (1) A cancellation fee waiver; (2) Travel assistance services. (D) Surplus lines brokers selling travel insurance shall pay taxes on premiums related to travel insurance in accordance with sections 3905.30 to 3905.38 of the Revised Code and not in accordance with the requirements of this ...

...icensed insurance agent entering active service in the United States armed forces; (4) Any other person if the superintendent determines that the public interest will best be served by the issuance of the license. (B) A temporary license issued under division (A) of this section shall remain in force for a period not to exceed one hundred eighty days. However, a temporary license may not continue in force under any...