Section 3902.50 | Definitions for R.C. 3902.50 to 3902.72.
(A) "Ambulance" has the same meaning as in section 4765.01 of the Revised Code.
(B) "Clinical laboratory services" has the same meaning as in section 4731.65 of the Revised Code.
(C) "Cost sharing" means the cost to a covered person under a health benefit 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 Code.
(F) "Drug" has the same meaning as in section 4729.01 of the Revised Code.
(G) "Emergency facility" has the same meaning as in section 3701.74 of the Revised Code.
(H) "Emergency services" means all of the following as described in 42 U.S.C. 1395dd:
(1) Medical screening examinations undertaken to determine whether an emergency medical condition exists;
(2) Treatment necessary to stabilize an emergency medical condition;
(3) Appropriate transfers undertaken prior to an emergency medical condition being stabilized.
(I) "Health care practitioner" has the same meaning as in section 3701.74 of the Revised Code.
(J) "Pharmacy benefit manager" has the same meaning as in section 3959.01 of the Revised Code.
(K) "Prior 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 procedures conducted prior to providing a health care service, device, or drug.
(L) "Unanticipated out-of-network care" means health care services, including clinical laboratory services, that are covered under a health benefit plan and that are provided by an out-of-network provider when either of the following conditions applies:
(1) The covered person did not have the ability to request such services from an in-network provider.
(2) The services provided were emergency services.
Last updated September 9, 2021 at 5:16 PM