reglab/housing_qa huggingface dataset:
Ohio Rev Code § 3902.11 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.11 | Coordination of Benefits Definitions.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|As used in sections 3902.11 to 3902.14 of the Revised Code:(A) "Beneficiary" and "third-party payer" have the same meanings as in section 3901.38 of the Revised Code.(B) "Plan of health coverage" means any of the following if the policy, contract, or agreement contains a coordination of benefits provision:(1) An individual or group sickness and accident insurance policy, which policy provides for hospital, dental, surgical, or medical services;(2) Any individual or group contract of a health insuring corporation, which contract provides for hospital, dental, surgical, or medical services;(3) Any other individual or group policy or agreement under which a third-party payer provides for hospital, dental, surgical, or medical services.(C) "Provider" means a hospital, nursing home, physician, podiatrist, dentist, pharmacist, chiropractor, or other licensed health care provider entitled to reimbursement by a third-party payer for services rendered to a beneficiary under a benefits contract.
Ohio Rev Code § 3902.12 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.12 | Primary or Secondary Health Coverage.

Effective: June 29, 1988|Latest Legislation:  Senate Bill 169 - 117th General Assembly|When a plan of health coverage is primary, its benefits are paid without regard to the benefits of another plan. When a plan of health coverage is secondary, its benefits are determined by taking into consideration the payments made or to be made by another plan. When there are more than two plans, a plan may be primary as to one and may be secondary as to another.
Ohio Rev Code § 3902.14 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.14 | Rules.

Effective: June 29, 1988|Latest Legislation:  Senate Bill 169 - 117th General Assembly|The superintendent of insurance may, pursuant to Chapter 119. of the Revised Code, adopt rules to carry out the purposes of sections 3902.11 to 3902.14 of the Revised Code.
Ohio Rev Code § 3902.21 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.21 | Standard Claim Form Definitions.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|As used in sections 3902.22 and 3902.23 of the Revised Code, "third-party payer" has the same meaning as in section 3901.38 of the Revised Code.
Ohio Rev Code § 3902.22 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.22 | Superintendent to Develop Standard Claim Form.

Effective: April 6, 2007|Latest Legislation:  House Bill 403 - 126th General Assembly|The superintendent of insurance shall develop a standard claim form to be used by all third-party payers and providers 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 established by the sickness and accident insurance industry, the superintendent shall amend the rules to comply with the national standards. The standard claim form shall include a method to specify the national provider identifiers assigned to the physical therapists and other health care professionals rendering services designated as physical therapy, as required under section 4755.56 of the Revised Code.
Ohio Rev Code § 3902.23 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.23 | Use of Form Mandatory.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|Beginning one hundred eighty days after rules adopted under section 3902.22 of the Revised Code take effect, no third-party payer shall fail to use the standard claim form prescribed in those rules.
Ohio Rev Code § 3902.30 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.30 | Coverage for Telemedicine Services.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) As used in this section: (1) "Health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code. (2) "Health care professional" means any of the following: (a) A physician licensed under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery; (b) A physician assistant licensed under Chapter 4731. of the Revised Code; (c) An advanced practice registered nurse as defined in section 4723.01 of the Revised Code. (3) "In-person health care services" means health care services delivered by a health care professional through the use of any communication method where the professional and patient are simultaneously present in the same geographic location. (4) "Recipient" means a patient receiving health care services or a health care professional with whom the provider of health care services is consulting regarding the patient. (5) "Telemedicine services" means a mode of providing health care services through synchronous or asynchronous information and communication technology by a health care professional, within the professional's scope of practice, who is located at a site other than the site where the recipient is located. (B)(1) A health benefit plan shall provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for the provision of in-person health care services. (2) A health benefit plan shall not exclude coverage for a service solely because it is provided as a telemedicine service. (C) A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telemedicine services other than such a benefit maximum imposed on all benefits offered under the plan. (D) This section shall not be construed as doing any of the following: (1) Prohibiting a health benefit plan from assessing cost-sharing requirements to a covered individual for telemedicine services, provided that such cost-sharing requirements for telemedicine services are not greater than those for comparable in-person health care services; (2) Requiring a health plan issuer to reimburse a health care professional for any costs or fees associated with the provision of telemedicine services that would be in addition to or greater than the standard reimbursement for comparable in-person health care services; (3) Requiring a health plan issuer to reimburse a telemedicine provider for telemedicine services at the same rate as in-person services. (E) This section applies to all health benefit plans issued, offered, or renewed on or after January 1, 2021.
Ohio Rev Code § 3902.31 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.31 | Void Contracts.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) As used in this section: (1) "Pay in full" means paying for a health service in its entirety without cost-sharing on the part of a third-party payer. "Pay in full" includes payment made under a deductible requirement. (2) "Third-party payer" and "provider" have the same meanings as in section 3901.38 of the Revised Code. (B)(1) Subject to division (C) of this section, a provision in a contract entered into between a third-party payer and a provider is void and against public policy if it does either of the following: (a) Establishes a minimum amount that the provider is required to charge an individual for a health service when that individual pays in full for the service; (b) Prohibits a provider from advertising the provider's rates for a service. (2) Division (B)(1)(b) of this section shall not be construed as prohibiting a provision in a contract between a provider and a third-party payer that prohibits a provider from disclosing or advertising contractually agreed upon reimbursement rates for providers. (C)(1) This section shall apply to all new contracts between a third-party payer and a provider entered into on or after the effective date of this section. (2) For existing contracts, this section shall apply on the earlier of either of the following: (a) Three years after the effective date of this section; (b) The expiration date of the contract or renewal of the contract.
Ohio Rev Code § 3902.36 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.36 | Compliance With Federal Mental Health and Addiction Parity Laws.

Effective: March 24, 2021|Latest Legislation:  Senate Bill 284 - 133rd General Assembly|(A) As used in this section: (1) "Health benefit plan" and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code. (2) "Mental Health Parity and Addiction Equity Act" means the federal "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008," Pub. L. No. 110-343, as amended, and any federal regulations implementing that act. (B) Each health plan issuer and health benefit plan subject to the Mental Health Parity and Addiction Equity Act shall comply with all applicable requirements of that act. The requirements of this section do not apply to a health plan issuer or a health benefit plan that is exempt from the requirements of that act by operation of law or other federal guidance. (C) The superintendent of insurance shall implement and enforce all applicable provisions of the Mental Health Parity and Addiction Equity Act and shall do all of the following: (1) Proactively ensure compliance by health plan issuers; (2) Evaluate all consumer and provider complaints regarding mental health and substance use disorder benefits for possible parity violations; (3) Adopt rules in accordance with Chapter 119. of the Revised Code as necessary to do both of the following: (a) Effectuate any provisions of the Mental Health Parity and Addiction Equity Act that relate to the business of insurance; (b) Enforce, monitor compliance with, and ensure continued compliance with this section. (D) Nothing in this section is subject to the requirements of section 3901.71 of the Revised Code.
Ohio Rev Code § 3902.50 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.50 | Definitions for r.c. 3902.50 to 3902.72.

Effective: September 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|As used in sections 3902.50 to 3902.72 of the Revised Code: (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
Ohio Rev Code § 3902.53 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.53 | Out-of-Network Care Rules, Prompt Pay Requirements, Violations.

Effective: April 12, 2021|Latest Legislation:  House Bill 388 - 133rd General Assembly|(A)(1) Except as provided in division (A)(2) of this section, sections 3901.38 to 3901.3814 of the Revised Code shall not apply with respect to a claim during a period of negotiation under section 3902.51 of the Revised Code or a period of arbitration under section 3902.52 of the Revised Code. Sections 3901.38 to 3901.3814 of the Revised Code shall apply upon the completion of a successful negotiation or upon the rendering of an arbitration decision. (2) The superintendent of insurance may adopt rules pursuant to division (D) of section 3902.54 of the Revised Code specifying situations in which sections 3901.38 to 3901.3814 of the Revised Code apply during periods of negotiation under section 3902.51 of the Revised Code. (B) A pattern of continuous or repeated violations of section 3902.51 or 3902.52 of the Revised Code by a health plan issuer is an unfair and deceptive act or practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code. (C) A provider who violates section 3902.51 or 3902.52 of the Revised Code shall be subject to professional discipline under Title XLVII of the Revised Code as applicable.
Ohio Rev Code § 3902.60 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.60 | Advanced Cancer Fail First Drug Coverage Definitions.

Effective: September 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|As used in sections 3902.60 and 3902.61 of the Revised Code: (A) "Associated conditions" means the symptoms or side effects of stage four advanced metastatic cancer, or the treatment thereof, which would, in the judgment of the health care practitioner in question, jeopardize the health of a covered individual if left untreated. (B) "Stage four advanced metastatic cancer" means a cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body. Last updated August 31, 2021 at 4:37 PM
Ohio Rev Code § 3902.61 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.61 | Advanced Cancer Fail First Drug Coverage Prohibitions.

Effective: March 24, 2021|Latest Legislation:  Senate Bill 252 - 133rd General Assembly|(A) Notwithstanding section 3901.71 and sections 3901.831 to 3901.833 of the Revised Code, a health benefit plan issued, delivered, or renewed in this state on or after the effective date of this section that directly or indirectly covers the treatment of stage four advanced metastatic cancer shall not make coverage of a drug that is prescribed to treat such cancer or associated conditions dependent upon a covered person demonstrating either of the following: (1) Failure to successfully respond to a different drug;  (2) A history of failing to respond to a different drug or drugs. (B) Division (A) of this section applies only to uses of such drug or drugs that are consistent with either of the following: (1) An indication approved by, or described in, as applicable, either of the following for the treatment of stage four advanced metastatic cancer: (a) The United States food and drug administration;  (b) The national comprehensive cancer network drugs and biologics compendium.  (2) The best practices for the treatment of stage four advanced metastatic cancer, as supported by peer-reviewed medical literature. (C) A violation of this section is an unfair and deceptive practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.
Ohio Rev Code § 3902.70 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.70 | Health Plan Issuer Contracts With 340b Program Participants Definitions.

Effective: September 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|As used in this section and section 3902.71 of the Revised Code: (A) "340B covered entity" and "third-party administrator" have the same meanings as in section 5167.01 of the Revised Code. (B) "Terminal distributor of dangerous drugs" has the same meaning as in section 4729.01 of the Revised Code. Last updated August 31, 2021 at 4:37 PM
Ohio Rev Code § 3902.71 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3902 | Insurance Policies and Contracts|Section 3902.71 | Health Plan Issuer Contracts With 340b Program Participants.

Effective: April 12, 2021|Latest Legislation:  Senate Bill 263 - 133rd General Assembly|(A) On and after the effective date of this section , a contract entered into between a health plan issuer, including a third-party administrator, and a 340B covered entity shall not contain any of the following provisions: (1) A reimbursement rate for a prescription drug that is less than the national average drug acquisition cost rate for that drug as determined by the United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition cost of the drug, as defined in 42 U.S.C. 1395w-3a(c)(6)(B); (2) A dispensing fee reimbursement amount that is less than the reimbursement amount provided to a terminal distributor of dangerous drugs under section 5164.753 of the Revised Code; (3) A fee that is not imposed on a health care provider that is not a 340B covered entity; (4) A fee amount that exceeds the fee amount for a health care provider that is not a 340B covered entity. (B) No health plan issuer or third-party administrator making payments pursuant to a health benefit plan shall discriminate against a 340B covered entity in a manner that prevents or interferes with an enrollee's choice to receive a prescription drug from a 340B covered entity or its contracted pharmacies. (C) Any provision of a contract entered into between a health plan issuer and a 340B covered entity that is contrary to division (A) of this section is unenforceable and shall be replaced with the dispensing fee or reimbursement rate that applies for health care providers that are not 340B covered entities.
Ohio Rev Code § 3903.02 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3903 | Reserve Valuation; Rehabilitation and Liquidation|Section 3903.02 | Citing of Act - Purpose of Act.

Effective: March 7, 1983|Latest Legislation:  House Bill 830 - 114th General Assembly|(A) Sections 3903.01 to 3903.59 of the Revised Code may be cited as "the insurers supervision, rehabilitation, and liquidation act."(B) Sections 3903.01 to 3903.59 of the Revised Code do not limit the powers granted the superintendent of insurance under any other section of the Revised Code.(C) Sections 3903.01 to 3903.59 of the Revised Code shall be liberally construed to effect the purpose stated in division (D) of this section.(D) The purpose of sections 3903.01 to 3903.59 of the Revised Code is the protection of the interests of insureds, claimants, creditors, and the public generally, with minimum interference with the normal prerogatives of the owners and managers of insurers, through all of the following:(1) Early detection of any potentially dangerous condition in an insurer, and prompt application of appropriate corrective measures;(2) Improved methods for rehabilitating insurers, involving the cooperation and management expertise of the insurance industry;(3) Enhanced efficiency and economy of liquidation, through clarification of the law, to minimize legal uncertainty and litigation;(4) Equitable apportionment of any unavoidable loss;(5) Lessening the problems of interstate rehabilitation and liquidation by facilitating cooperation between states in the liquidation process, and by extending the scope of personal jurisdiction over debtors of the insurer outside this state;(6) Regulation of the insurance business by the impact of the law relating to delinquency procedures and substantive rules on the entire insurance business.
Ohio Rev Code § 3903.03 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3903 | Reserve Valuation; Rehabilitation and Liquidation|Section 3903.03 | Application of Sections.

Effective: March 7, 1983|Latest Legislation:  House Bill 830 - 114th General Assembly|The proceedings authorized by sections 3903.01 to 3903.59 of the Revised Code may be applied to any one or more of the following:(A) All insurers who are doing, or have done, an insurance business in this state, and against whom claims arising from that business may exist now or in the future;(B) All insurers who purport to do an insurance business in this state;(C) All insurers who have insureds resident in this state;(D) All other persons organized or in the process of organizing with the intent to do an insurance business in this state;(E) All other companies, associations, societies, or entities subject to regulation by the superintendent of insurance under Titles XVII and XXXIX of the Revised Code.