Effective: June 25, 2008 Latest Legislation: House Bill 125 – 127th General Assembly As used in this chapter, “basic health care services,” “enrollee,” “health care facility,” “health care services,” “health insuring corporation,” “medical record,” “person,” “primary care provider,” “provider,” “specialty health care services,” “subscriber,” and “supplemental health care services” have the same meanings as in […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly A health insuring corporation shall notify a provider seeking to enter into a participation contract with the health insuring corporation of the status of the provider’s application within one hundred twenty days after the health insuring corporation’s receipt of the provider’s completed […]
Effective: June 25, 2008 Latest Legislation: House Bill 125 – 127th General Assembly (A)(1) Prior to entering into a participation contract with a provider under section 1751.13 of the Revised Code, a health insuring corporation shall disclose basic information regarding its programs and procedures to the provider. The information shall include all of the following: […]
Effective: March 20, 2019 Latest Legislation: House Bill 156 – 132nd General Assembly (A) Except as provided in division (D) of this section, prior to terminating the participation of a provider on the basis of the participating provider’s failure to meet the health insuring corporation’s standards for quality or utilization in the delivery of health […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly Nothing in this chapter or Chapter 1751. of the Revised Code requires a health insuring corporation to employ or contract with, or prohibits a health insuring corporation from employing or contracting with, any category of provider for the provision of basic or […]
Effective: October 14, 1999 Latest Legislation: House Bill 4 – 123rd General Assembly Every individual or group health insuring corporation policy, contract, or agreement that provides basic health care services but does not allow direct access to obstetricians or gynecologists shall permit a female enrollee to obtain covered obstetric and gynecological services from a participating […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly (A) A health insuring corporation that does not allow direct access to all specialists shall establish and implement a procedure by which an enrollee may receive a standing referral to a specialist. The procedure shall provide for a standing referral to a […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly A health insuring corporation or utilization review organization that authorizes a proposed admission, treatment, or health care service by a participating provider based upon the complete and accurate submission of all necessary information relative to an eligible enrollee shall not retroactively deny […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly (A) If a policy, contract, or agreement of a health insuring corporation uses a restricted formulary of prescription drugs, the health insuring corporation shall do both of the following: (1) Develop such a formulary in consultation with and with the approval of […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly A health insuring corporation that provides basic health care services shall establish or use an internal technology assessment process for assessing whether a drug, device, protocol, procedure, or other therapy is proven to be safe and efficacious for a particular indication or […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly (A) As used in this section: (1) “Emergency medical condition” means a medical condition that manifests itself by such acute symptoms of sufficient severity, including severe pain, that a prudent layperson with an average knowledge of health and medicine could reasonably expect […]
Effective: October 1, 1998 Latest Legislation: House Bill 361 – 122nd General Assembly Nothing in this chapter shall prevent or otherwise affect the application to any health care plan of those provisions of Title XVII or XXXIX of the Revised Code that would otherwise apply.
Effective: January 1, 2021 Latest Legislation: House Bill 339 – 133rd General Assembly As used in sections 1753.31 to 1753.43 of the Revised Code: (A) “Adjusted RBC report” means an RBC report that has been adjusted by the superintendent of insurance in accordance with division (C) of section 1753.32 of the Revised Code. (B) “Authorized […]
Effective: March 15, 2001 Latest Legislation: House Bill 714 – 123rd General Assembly (A) Each domestic health insuring corporation shall, on or prior to the first day of March of every year, prepare and submit to the superintendent of insurance a report on its RBC levels as of the end of the calendar year just […]
Effective: January 1, 2012 Latest Legislation: House Bill 300 – 128th General Assembly (A) For purposes of sections 1753.31 to 1753.43 of the Revised Code, a “company action level event” is any of the following events: (1) A health insuring corporation’s filing of an RBC report that indicates that the health insuring corporation’s total adjusted […]
Effective: March 15, 2001 Latest Legislation: House Bill 714 – 123rd General Assembly (A) For purposes of sections 1753.31 to 1753.43 of the Revised Code, a “regulatory action level event” is any of the following events: (1) The filing of an RBC report by a health insuring corporation that indicates that the health insuring corporation’s […]
Effective: March 15, 2001 Latest Legislation: House Bill 714 – 123rd General Assembly (A) For purposes of sections 1753.31 to 1753.43 of the Revised Code, an “authorized control level event” is any of the following events: (1) The filing of an RBC report by a health insuring corporation that indicates that the health insuring corporation’s […]
Effective: March 15, 2001 Latest Legislation: House Bill 714 – 123rd General Assembly (A) For purposes of sections 1753.31 to 1753.43 of the Revised Code, a “mandatory control level event” is any of the following events: (1) The filing of an RBC report by a health insuring corporation that indicates that the health insuring corporation’s […]
Effective: March 15, 2001 Latest Legislation: House Bill 714 – 123rd General Assembly (A) A health insuring corporation has the right to a confidential hearing upon receiving any of the following from the superintendent of insurance: (1) An adjusted RBC report; (2) Notification that the health insuring corporation’s RBC plan or revised RBC plan is […]
Effective: March 15, 2001 Latest Legislation: House Bill 714 – 123rd General Assembly (A) The superintendent of insurance shall keep all of the following confidential: (1) An RBC report, to the extent that information contained in the report is not required to be included in an annual statement available to the public; (2) An RBC […]
