Ohio Revised Code Search

... (A) A discount medical plan organization shall not offer to members, or advertise to prospective members, discounted medical services unless the services are offered pursuant to a provider agreement. A discount medical plan organization may enter into a provider agreement directly with a provider, indirectly through a provider network to which a provider belongs, or through another discount medical plan organization...

...(A) Prior to a discount medical plan organization allowing a marketer to market, promote, sell, or distribute a discount medical plan, the organization shall enter into a written agreement with the marketer. This agreement shall prohibit the marketer from using or issuing any advertising, marketing materials, brochures, or discount medical cards without the organization's written approval. (B) A discount medical pla...

... (A) A discount medical plan organization or marketer shall disclose all of the following information in writing in not less than twelve-point type on the first content page of any advertisements, marketing materials, or brochures made available to the public relating to a discount medical plan and with any enrollment forms: (1) A statement that the discount medical plan is not insurance; (2) A statement tha...

... A discount medical plan organization shall not do any of the following: (A) Except when otherwise permitted in sections 3961.01 to 3961.09 of the Revised Code, as a disclaimer of any relationship between discount medical plan benefits and insurance, or in a description of an insurance product connected with a discount medical plan, use the term "insurance" in the organization's advertisements, marketing material, b...

... (A) A discount medical plan organization shall permit members to cancel membership in a discount medical plan at any time. (B) If a member gives notice of cancellation within thirty days after the date the member receives the written document described in division (C) of section 3961.04 of the Revised Code for the discount medical plan, the discount medical plan organization, within thirty days of the member giving...

... (A) The superintendent of insurance may examine or investigate the business and affairs of a discount medical plan organization as the superintendent deems appropriate to protect the interests of the residents of this state. (B) When examining or investigating a discount medical plan organization pursuant to division (A) of this section, the superintendent may do both of the following: (1) Order a discount medical...

... (A) No person shall fail to comply with sections 3961.01 to 3961.09 of the Revised Code. If the superintendent of insurance determines that any person has violated sections 3961.01 to 3961.07 of the Revised Code, the superintendent may take one or more of the following actions: (1) Assess a civil penalty in an amount not to exceed twenty-five thousand dollars per violation if the person knew or should have known o...

... The superintendent of insurance may adopt rules in accordance with Chapter 119. of the Revised Code for purposes of implementing sections 3961.01 to 3961.08 of the Revised Code.

... As used in this chapter: (A) "Affiliate" means any person or entity that has ownership or control of a contracting entity, is owned or controlled by a contracting entity, or is under common ownership or control with a contracting entity. (B) "Basic health care services" has the same meaning as in division (A) of section 1751.01 of the Revised Code, except that it does not include any services listed in that divi...

... (A)(1) No contracting entity shall sell, rent, or give a third party the contracting entity's rights to a participating provider's services pursuant to the contracting entity's health care contract with the participating provider unless one of the following applies: (a) The third party accessing the participating provider's services under the health care contract is an employer or other entity providing coverage f...

... (A) Each health care contract shall include all of the following information: (1)(a) Information sufficient for the participating provider to determine the compensation or payment terms for health care services, including all of the following, subject to division (A)(1)(b) of this section: (i) The manner of payment, such as fee-for-service, capitation, or risk; (ii) The fee schedule of procedure codes reasonab...

...(A)(1) If an amendment to a health care contract is not a material amendment, the contracting entity shall provide the participating provider notice of the amendment at least fifteen days prior to the effective date of the amendment. The contracting entity shall provide all other notices to the participating provider pursuant to the health care contract. (2) A material amendment to a health care contract shall...

...(A) The department of insurance shall prescribe the credentialing application form used by the council for affordable quality healthcare (CAQH) in electronic or paper format for physicians. The department of insurance also shall prepare the standard credentialing form for all other providers and shall make the standard credentialing form as simple, straightforward, and easy to use as possible, having due reg...

...(A) If a provider, upon the oral or written request of a contracting entity to submit a credentialing form, submits a credentialing form that is not complete, the contracting entity that receives the form shall notify the provider of the deficiency electronically, by facsimile, or by certified mail, return receipt requested, not later than twenty-one days after the contracting entity receives the form. (B) ...

...(A) All remittance notices sent by a payer, whether written or electronic, shall include both of the following: (1) The name of the payer issuing the payment to the participating provider; (2) The name of the contracting entity through which the payment rate and any discount are claimed, if the contracting entity is different from the payer. (B) Division (A) of this section takes effect March 31, 2009.

...The superintendent of insurance shall adopt any rules necessary for the implementation of this chapter.

...(A) A series of violations of this chapter by any person regulated by the department of insurance under Title XVII or Title XXXIX of the Revised Code that, taken together, constitute a pattern or practice of violating this chapter may be defined as an unfair and deceptive insurance practice under sections 3901.19 to 3901.26 of the Revised Code. (B) The superintendent of insurance may conduct a market conduct ...

... This chapter does not apply with respect to any of the following: (A) A contract or provider agreement between a provider and the state or federal government, a state agency, or federal agency for health care services provided through a program for medicaid or medicare; (B) A contract for payments made to providers for rendering health care services to claimants pursuant to claims made under Chapter 412...

...(A) No contracting entity shall do any of the following: (1) Offer to a provider a health care contract that includes a most favored nation clause; (2) Enter into a health care contract with a provider that includes a most favored nation clause; (3) Amend or renew an existing health care contract previously entered into with a provider so that the contract as amended or renewed adds or continues to include a...

...As used in this chapter: (A) "Affiliated company" means any company in the same corporate system as a parent, or a member organization by virtue of common ownership, control, operation, or management. (B) "Captive insurance company" means any insurer that insures only the risks of its parent or affiliated companies of its parent. "Captive insurance company" includes any protected cell captive insurance compan...

... (A) A captive insurance company may apply for authority to insure only the following lines of insurance: (1) Commercial multiple peril; (2) Ocean marine; (3) Inland marine; (4) Medical malpractice; (5) Workers' compensation, to the extent permitted by law, but only for the purpose of indemnification of a self-insuring employer pursuant to division (B)(1) of section 4123.82 of the Revised Code; (6) Commerc...

... (A) A captive insurance company shall be organized under Chapter 1701., 1702., 1705., or 1706. of the Revised Code. (B) A captive insurance company shall not operate in this state unless all of the following are met: (1) The captive insurance company obtains from the superintendent a license to do the business of captive insurance in this state. (2) The captive insurance company's board of directors holds a...

... No captive insurance company shall adopt a name that is the same, deceptively similar, or likely to be confused with, or mistaken for, any other existing business name registered in this state. The name under which a captive insurance company engages in business must contain the word "captive."

...(A) No captive insurance company shall be issued a license unless it possesses and maintains minimum unimpaired, paid-in total capital and surplus as follows: (1) Not less than two hundred fifty thousand dollars; (2) In the case of a protected cell captive insurance company, not less than five hundred thousand dollars. (B) The superintendent may prescribe additional capital and surplus based upon the type, vo...

... (A) No captive insurance company shall pay any extraordinary dividend or make any other extraordinary distribution to its shareholders or members other than in accordance with this section. The declaration of an extraordinary dividend or distribution shall be conditional and shall confer no rights upon shareholders or members until thirty days after the superintendent has received notice of the declaration the...