reglab/housing_qa huggingface dataset:
Ohio Rev Code § 3923.50 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.50 | Notifying Department of Job and Family Services of Long-Term Care Insurance Policies That Comply With Insurance Department Requirements.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|For the purposes of the Ohio long-term care insurance program established under section 5164.86 of the Revised Code, the department of insurance shall notify the department of medicaid of all long-term care insurance policies that meet all of the following requirements: (A) Comply with sections 3923.41 to 3923.48 of the Revised Code and the rules adopted under section 3923.47 of the Revised Code;(B) Provide benefits for home and community-based services in addition to nursing home care;(C) Include case management services in its coverage of home and community-based services;(D) Provide five per cent inflation protection compounded annually;(E) Provide for the keeping of records and explanation-of-benefit reports on insurance payments that count toward resource exclusion for the medicaid program;(F) Provide the information the medicaid director determines is necessary to document the extent of resource exclusion and to evaluate the Ohio long-term care insurance program;(G) Comply with other requirements established in rules adopted under this section.The superintendent of insurance shall adopt rules in accordance with Chapter 119. of the Revised Code establishing requirements under division (G) of this section that policies must meet to qualify under the Ohio long-term care insurance program. The superintendent shall consult with the departments of aging and medicaid in adopting those rules.
Ohio Rev Code § 3923.51 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.51 | Group Contracts of Sickness and Accident Insurance Persons Under Nineteen Who Are Members of Impoverished Families.

Effective: March 30, 2007|Latest Legislation:  Senate Bill 116 - 126th General Assembly|(A) As used in this section, "official poverty line" means the poverty line as defined by the United States office of management and budget and revised by the secretary of health and human services under 95 Stat. 511, 42 U.S.C.A. 9902, as amended.(B) Every insurer that is authorized to write sickness and accident insurance in this state may offer group contracts of sickness and accident insurance to any charitable foundation that is certified as exempt from taxation under section 501(c)(3) of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 1, as amended, and that has the sole purpose of issuing certificates of coverage under these contracts to persons under the age of nineteen who are members of families that have incomes that are no greater than three hundred per cent of the official poverty line.(C) Contracts offered pursuant to division (B) of this section are not subject to any of the following:(1) Sections 3923.122, 3923.24, 3923.28, 3923.281, and 3923.29 of the Revised Code;(2) Any other sickness and accident insurance coverage required under this chapter on August 3, 1989. Any requirement of sickness and accident insurance coverage enacted after that date applies to this section only if the subsequent enactment specifically refers to this section.(3) Chapter 1751. of the Revised Code.
Ohio Rev Code § 3923.55 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.55 | Policy to Include Benefits for Child Health Supervision Services From Moment of Birth Until Age Nine.

Effective: August 1, 2002|Latest Legislation:  House Bill 150 - 124th General Assembly|(A) As used in this section and section 3923.56 of the Revised Code: (1) "Child health supervision services" means periodic review of a child's physical and emotional status performed by a physician, by a health care professional under the supervision of a physician, or, in the case of hearing screening, by an individual acting in accordance with section 3701.505 of the Revised Code.(2) "Periodic review" means a review performed in accordance with the recommendations of the American academy of pediatrics and includes a history, complete physical examination, developmental assessment, anticipatory guidance, appropriate immunizations, and laboratory tests.(3) "Physician" means a person authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.(B) Notwithstanding section 3901.71 of the Revised Code, each policy of individual or group sickness and accident insurance delivered, issued for delivery, or renewed in this state on or after the effective date of this amendment, that provides coverage for family members of the insured shall provide, with respect to that coverage, that any benefits applicable for children shall include benefits for child health supervision services from the moment of birth until age nine. (C) A policy that provides the benefits described in division (B) of this section may limit the benefits to cover only the expenses of child health supervision services that are performed by one physician or by a health care professional under the supervision of one physician during the course of any one visit.(D) Copayments and deductibles shall be reasonable and shall not be a barrier to the necessary utilization of child health supervision services by covered persons.(E) Benefits for child health supervision services that are provided to a child during the period from birth to age one shall not exceed a maximum limit of five hundred dollars, including benefits for the hearing screening required by the program established under section 3701.504 of the Revised Code. The benefits for the hearing screening shall not exceed a maximum limit of seventy-five dollars. Benefits for child health supervision services that are provided to a child during any year thereafter shall not exceed a maximum limit of one hundred fifty dollars per year.(F) This section does not apply to any policy that provides coverage for specific diseases or accidents only, or to any hospital indemnity, medicare supplement, or other policy that offers only supplemental benefits.
Ohio Rev Code § 3923.56 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.56 | Plan to Include Benefits for Child Health Supervision Services From Moment of Birth Until Age Nine.

Effective: August 1, 2002|Latest Legislation:  House Bill 150 - 124th General Assembly|(A) Notwithstanding section 3901.71 of the Revised Code, each employee benefit plan established or maintained in this state on or after the effective date of this amendment that provides coverage for family members of the employee shall provide, with respect to that coverage, that any benefits applicable for children shall include benefits for child health supervision services from the moment of birth until age nine. (B) A plan that provides the benefits described in division (A) of this section may limit the benefits to cover only the expenses of child health supervision services that are performed by one physician or by a health care professional under the supervision of one physician during the course of any one visit.(C) Copayments and deductibles shall be reasonable and shall not be a barrier to the necessary utilization of child health supervision services by covered persons.(D) Benefits for child health supervision services that are provided to a child during the period from birth to age one shall not exceed a maximum limit of five hundred dollars, including benefits for the hearing screening required by the program established under section 3701.504 of the Revised Code. The benefits for the hearing screening shall not exceed a maximum limit of seventy-five dollars. Benefits for child health supervision services that are provided to a child during any year thereafter shall not exceed a maximum limit of one hundred fifty dollars per year.
Ohio Rev Code § 3923.582 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.582 | [Suspended Eff. 1/1/2014 to 1/1/2022, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Open Enrollment Coverage - Responsibilities of Superintendent of Insurance.

Effective: October 16, 2009|Latest Legislation:  House Bill 1 - 128th General Assembly|(A) The superintendent of insurance may adopt rules in accordance with Chapter 119. of the Revised Code to implement sections 3923.58 and 3923.581 of the Revised Code, including, but not limited to, rules relating to both of the following:(1) Requirements for adequate notice by carriers to consumers of the availability and premium rates of open enrollment coverage;(2) Reporting and data collection requirements for implementation of the open enrollment program and to evaluate the performance of the open enrollment program and the individual health insurance market of this state.(B) On or before June 30, beginning calendar year 2011 and continuing every year thereafter, the superintendent shall issue a report to the governor and the general assembly on the open enrollment program and the performance of the individual health insurance market in this state. The report shall include a determination by the superintendent, supported by a signed letter from a member of the American academy of actuaries, as to whether the amendments by this act to sections 3923.58 and 3923.581 of the Revised Code, have caused the market-wide average medical loss ratio for coverage sold to individual insureds and nonemployer group insureds in this state, including open enrollment insureds, to increase and, if so, by how many percentage points. Last updated January 19, 2022 at 11:04 AM
Ohio Rev Code § 3923.59 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.59 | [Suspended Eff. 1/1/2014 Through 1/1/2022, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Open Enrollment Reinsurance Program.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|Any insurer may reinsure coverage of any individual or nonemployer group acquired under section 3923.58 or 3923.581 of the Revised Code with the open enrollment reinsurance program in accordance with division (G) of section 3924.11 of the Revised Code. Premium rates charged for coverage reinsured by the program shall be established in accordance with section 3924.12 of the Revised Code. Last updated January 19, 2022 at 11:04 AM
Ohio Rev Code § 3923.62 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.62 | Disclosing Determination of Usual and Customary Fee for Dental Benefits.

Effective: October 12, 1994|Latest Legislation:  House Bill 433 - 120th General Assembly|(A) Each insurer that delivers, issues for delivery, or renews individual or group sickness and accident insurance policies providing dental benefits, and that bases payment for those benefits on a usual and customary fee charged by dentists, and each administrator of a self-insured dental plan that bases payment for dental benefits on a usual and customary fee charged by dentists, shall disclose all of the following in accordance with division (B) of this section:(1) The frequency of the determination of the usual and customary fee;(2) A general description of the methodology used to determine usual and customary fees;(3) The geographic area used to determine usual and customary fees;(4) If the usual and customary fee for a service is determined by taking a sample of fees submitted on actual claims from dentists and then selecting a percentile of those fees, the percentile that is used by the insurer.(B) The insurer or administrator shall disclose the information described in division (A) of this section to a policyholder, certificate holder, or participant of a self-insured plan, if requested by the policyholder, certificate holder, or participant. The disclosure shall be made within thirty days after the insurer or administrator receives the request from the policyholder, certificate holder, or participant.(C) A violation of this section is an unfair and deceptive act or practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.(D) As used in this section, "administrator" means a person who is licensed under Chapter 3959. of the Revised Code.
Ohio Rev Code § 3923.65 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.65 | Coverage for Emergency Services.

Effective: March 23, 2015|Latest Legislation:  House Bill 201 - 130th 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 average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in any of the following:(a) Placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy;(b) Serious impairment to bodily functions;(c) Serious dysfunction of any bodily organ or part.(2) "Emergency services" means the following:(a) A medical screening examination, as required by federal law, that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department, to evaluate an emergency medical condition;(b) Such further medical examination and treatment that are required by federal law to stabilize an emergency medical condition and are within the capabilities of the staff and facilities available at the hospital, including any trauma and burn center of the hospital.(B) Every individual or group policy of sickness and accident insurance that provides hospital, surgical, or medical expense coverage shall cover emergency services without regard to the day or time the emergency services are rendered or to whether the policyholder, the hospital's emergency department where the services are rendered, or an emergency physician treating the policyholder, obtained prior authorization for the emergency services.(C) Every individual policy or certificate furnished by an insurer in connection with any sickness and accident insurance policy shall provide information regarding the following:(1) The scope of coverage for emergency services;(2) The appropriate use of emergency services, including the use of the 9-1-1 system and any other telephone access systems utilized to access prehospital emergency services;(3) Any copayments for emergency services.(D) This section does not apply to any individual or group policy of sickness and accident insurance covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, medicare, tricare, specified disease, or vision care; coverage under a one-timelimitedduration policy that is less than twelve months; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar law; automobile medical payment insurance; or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance. Last updated November 22, 2021 at 5:00 PM
Ohio Rev Code § 3923.81 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.81 | Covered Person's Payments Not to Exceed Insurer Payments.

Effective: March 23, 2007|Latest Legislation:  Senate Bill 5 - 126th General Assembly|(A) If a person is covered by a health benefit plan issued by a sickness and accident insurer, health insuring corporation, or multiple employer welfare arrangement and the person is required to pay for health care costs out-of-pocket or with funds from a savings account, the amount the person is required to pay to a health care provider or pharmacy shall not exceed the amount the sickness and accident insurer, health insuring corporation, or multiple employer welfare arrangement would pay under applicable reimbursement rates negotiated with the provider or pharmacy. This division does not preclude a person from reaching an agreement with a health care provider or pharmacy on terms that are more favorable to the person than negotiated reimbursement rates that otherwise would apply as long as the claim submitted reflects the alternative amount negotiated, except that a health care provider or pharmacy shall not waive all or part of a copay or deductible if prohibited by any other provision of the Revised Code. The requirements of this division do not apply to amounts owed to a provider or pharmacy with whom the sickness and accident insurer, health insuring corporation, or multiple employer welfare arrangement has no applicable negotiated reimbursement rate.(B) Each sickness and accident insurer, health insuring corporation, or multiple employer welfare arrangement shall establish and maintain a system whereby a person covered by a health benefit plan may obtain information regarding potential out of pocket costs for services provided by in-network providers.(C) As used in this section:(1) "Health benefit plan" means any policy of sickness and accident insurance or any policy, contract, or agreement covering one or more "basic health care services," "supplemental health care services," or "specialty health care services," as defined in section 1751.01 of the Revised Code, offered or provided by a health insuring corporation or by a sickness and accident insurer or multiple employer welfare arrangement.(2) "Reimbursement rates" means any rates that apply to a payment made by a sickness and accident insurer, health insuring corporation, or multiple employer welfare arrangement for charges covered by a health benefit plan.(3) "Savings account" includes health savings accounts, health reimbursement arrangements, flexible savings accounts, medical savings accounts, and similar accounts and arrangements.
Ohio Rev Code § 3923.82 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.82 | Coverage for Alcohol or Drug Related Losses or Expenses.

Effective: April 7, 2009|Latest Legislation:  House Bill 493 - 127th General Assembly|(A) As used in this section, "health benefit plan" has the same meaning as in section 3924.01 of the Revised Code. (B) Notwithstanding section 3901.71 of the Revised Code, no health benefit plan or public employee benefit plan shall contain a provision that limits or excludes an insured's coverage under the plan for a loss or expense the insured sustains that is the result of the insured's use of alcohol or other drugs or both and the loss or expense is otherwise covered under the plan.(C) Nothing in this section shall be construed as doing either of the following:(1) Requiring coverage for the treatment of alcohol or substance abuse except as otherwise required by law;(2) Prohibiting the enforcement of an exclusion based on injuries sustained by an insured during the commission of an offense by the insured in which the insured is convicted of or pleads guilty or no contest to a felony.(D) Not later than four years after the effective date of this section, the department of insurance shall conduct an analysis of the impact of the requirements of this section on the cost of and coverage provided by health benefit plans in this state and prepare a written report of its findings from the analysis. The department shall submit the report to the governor and, in accordance with section 101.68 of the Revised Code, to the general assembly.
Ohio Rev Code § 3923.86 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.86 | Statement Provided to Insureds Under Vision Policy.

Effective: March 20, 2019|Latest Legislation:  House Bill 156 - 132nd General Assembly|(A) As used in this section, "covered vision services," "vision care materials," and "vision care provider" have the same meanings as in section 3963.01 of the Revised Code. (B) A sickness and accident insurer or public employee benefit plan shall provide the information required in this division to all insured individuals receiving coverage under an individual or group policy of sickness and accident insurance or public employee benefit plan providing coverage for vision care services or vision care materials. The information shall be in a conspicuous format, shall be easily accessible to insured individuals, and shall do all of the following: (1) Include the following statement:  "IMPORTANT: If you opt to receive vision care services or vision care materials that are not covered benefits under this plan, a participating vision care provider may charge you his or her normal fee for such services or materials. Prior to providing you with vision care services or vision care materials that are not covered benefits, the vision care provider will p rovide you with an estimated cost for each service or material upon your request." (2) Disclose any business interest the insurer or plan has in a source or supplier of vision care materials ; (3) Include an explanation that the insured individual may incur out-of-pocket expenses as a result of the purchase of vision care services or vision care materials that are not covered vision services. The explanation shall be communicated in a manner and format similar to how the insurer or plan provides an insured individual with information on coverage levels and out-of-pocket expenses that may be incurred by the insured individual under the policy or plan when purchasing out-of-network vision care services or vision care materials.  (C) A pattern of continuous or repeated violations of this section is an unfair and deceptive act or practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.
Ohio Rev Code § 3923.87 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.87 | Compliance With Section 3959.20.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|Each sickness and accident insurer or public employee benefit plan shall comply with the requirements of section 3959.20 of the Revised Code as they pertain to health plan issuers. As used in this section, "health plan issuer" has the same meaning as in section 3922.01 of the Revised Code.
Ohio Rev Code § 3923.89 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.89 | Payment or Reimbursement to Pharmacist.

Effective: December 16, 2020|Latest Legislation:  House Bill 203 - 133rd General Assembly|A sickness and accident insurer or public employee benefit plan may provide payment or reimbursement to a pharmacist for providing a health care service to a patient if both of the following are the case: (A) The pharmacist provided the health care service to the patient in accordance with Chapter 4729. of the Revised Code, including any of the following services: (1) Managing drug therapy under a consult agreement pursuant to section 4729.39 of the Revised Code; (2) Administering immunizations in accordance with section 4729.41 of the Revised Code; (3) Administering drugs in accordance with section 4729.45 of the Revised Code. (B) The patient's individual or group policy of sickness and accident insurance or public employee benefit plan provides for payment or reimbursement of the service.