Ohio Revised Code Search

...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...

...t card payments, electronic processing service, and manual processing service. Fees collected under this section shall be credited to the department of insurance operating fund created under section 3901.021 of the Revised Code. (B) To assist the superintendent in carrying out the superintendent's duties under this chapter, the superintendent may contract with any nongovernmental entity, including the NAIC and...

...posing fees. The statutory fee for each service requested shall be charged against the proper account immediately upon the rendition of the service. Not later than the tenth day of each calendar month the superintendent shall render an itemized statement to each company or agent whose account has been charged during the month next preceding, showing the amount of all fees charged during that month and demandi...

...a vehicle protection device, system, or service that is installed on or applied to a vehicle and that is designed to deter the theft of a vehicle or facilitate the recovery of the vehicle after it has been stolen. "Vehicle protection product" includes, but is not limited to, alarm systems, window etch products, body part marking products, steering locks, pedal and ignition locks, fuel and ignition kill switches, and ...

...oose; (4) Provide any information or services related to health benefit plans or other products not offered in the exchange. Division (C)(4) of this section shall not be interpreted as prohibiting an insurance navigator from providing information on eligibility for medicaid; (5) Engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice. (D) An individual shall not ...

...on, an agent may charge a fee for agent services in connection with a policy issued on a no-commission basis, if the agent provides the consumer with prior disclosure of the fee and of the services to be provided. (D) In the event of a dispute between an agent and a consumer regarding any disclosure required by this section, the agent has the burden of proving that the disclosure was made. (E)(1) No person shall ...

... or any paid employment or contract for service of any kind, or anything of value; nor shall such company or person give or offer to give, or enter into any separate agreement promising to secure, as an inducement or consideration for insurance, the loan of any money, either directly or indirectly, or any contract for services; nor shall such company or person require as a condition of or in connection with the grant...