reglab/housing_qa huggingface dataset:
Ohio Rev Code § 3923.90 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.90 | Teledentistry to Be Included in Coverage.

Effective: March 20, 2019|Latest Legislation:  Senate Bill 259 - 132nd General Assembly|(A) As used in this section, "teledentistry" has the same meaning as in section 4715.43 of the Revised Code. (B) No individual or group policy of sickness and accident insurance or public employee benefit plan shall deny coverage for the costs of any services provided to an insured through teledentistry if those services would be covered if the services were delivered other than through teledentistry. (C) The coverage that may not be excluded under division (B) of this section is subject to all terms, conditions, restrictions, exclusions, and limitations that apply to any other coverage for services performed by participating and nonparticipating providers.
Ohio Rev Code § 3923.99 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3923 | Sickness and Accident Insurance|Section 3923.99 | Penalty.

Effective: January 1, 1980|Latest Legislation:  House Bill 43 - 113th General Assembly|Whoever violates section 3923.14, 3923.16, 3923.161, or 3923.21 of the Revised Code shall be fined not more than one thousand dollars.
Ohio Rev Code § 3924.02 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.02 | Health Care Benefit Plans Covered by Chapter.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|(A) An individual or group health benefit plan is subject to sections 3924.01 to 3924.14 of the Revised Code if it provides health care benefits covering at least two but no more than fifty employees of a small employer, and if it meets either of the following conditions:(1) Any portion of the premium or benefits is paid by a small employer, or any covered individual is reimbursed, whether through wage adjustments or otherwise, by a small employer for any portion of the premium.(2) The health benefit plan is treated by the employer or any of the covered individuals as part of a plan or program for purposes of section 106 or 162 of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 1, as amended.(B) Notwithstanding division (A) of this section, divisions (D), (E)(2), (F), and (G) of section 3924.03 of the Revised Code and section 3924.04 of the Revised Code do not apply to health benefit policies that are not sold to owners of small businesses as an employment benefit plan. Such policies shall clearly state that they are not being sold as an employment benefit plan and that the owner of the business is not responsible, either directly or indirectly, for paying the premium or benefits.(C) Every health benefit plan offered or delivered by a carrier, other than a health insuring corporation, to a small employer is subject to sections 3923.23, 3923.231, 3923.232, 3923.233, and 3923.234 of the Revised Code and any other provision of the Revised Code that requires the reimbursement, utilization, or consideration of a specific category of a licensed or certified health care practitioner.(D) Except as expressly provided in sections 3924.01 to 3924.14 of the Revised Code, no health benefit plan offered to a small employer is subject to any of the following:(1) Any law that would inhibit any carrier from contracting with providers or groups of providers with respect to health care services or benefits;(2) Any law that would impose any restriction on the ability to negotiate with providers regarding the level or method of reimbursing care or services provided under the health benefit plan;(3) Any law that would require any carrier to either include a specific provider or class of provider when contracting for health care services or benefits, or to exclude any class of provider that is generally authorized by statute to provide such care.
Ohio Rev Code § 3924.031 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.031 | Carrier Offering Health Benefit Plan in Small Employer Market Through Network Plan.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|(A) As used in this section and section 3924.032 of the Revised Code:(1) "Health status-related factor" means any of the following:(a) Health status;(b) Medical condition, including both physical and mental illnesses;(c) Claims experience;(d) Receipt of health care;(e) Medical history;(f) Genetic information;(g) Evidence of insurability, including conditions arising out of acts of domestic violence;(h) Disability.(2) "Network plan" means a health benefit plan of a carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier.(B) If a carrier offers a health benefit plan in the small employer market through a network plan, the carrier may do both of the following:(1) Limit the small employers that may apply for such coverage to those with eligible employees who live, work, or reside in the service area of the network plan;(2) Within the service area of the network plan, deny the coverage to small employers if the carrier has demonstrated both of the following to the superintendent of insurance:(a) The carrier will not have the capacity to deliver services adequately to the members of any additional groups because of the carrier's obligations to existing group contract holders and members.(b) The carrier is applying division (B)(2) of this section uniformly to all small employers without regard to the claims experience of those employers and their eligible employees and dependents or to any health status-related factor relating to such employees and dependents.(C) A carrier that, pursuant to division (B)(2) of this section, denies coverage to a small employer in the service area of a network plan, shall not offer coverage in the small employer market within that service area for at least one hundred eighty days after the date the coverage is denied.
Ohio Rev Code § 3924.032 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.032 | Refusing to Issue Plans in Small Employer Market.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|(A) A carrier may refuse to issue health benefit plans in the small employer market if the carrier has demonstrated both of the following to the superintendent of insurance:(1) The carrier does not have the financial reserves necessary to underwrite additional coverage.(2) The carrier is applying division (A) of this section uniformly to all employers in the small employer market in this state consistent with the applicable laws and rules of this state and without regard to the claims experience of those employers and their employees and dependents or to any health status-related factor relating to such employees and dependents.(B) A carrier that, pursuant to division (A) of this section, refuses to issue health benefit plans in the small employer market, shall not offer health benefit plans in the small employer market in this state for at least one hundred eighty days after the date the coverage is denied or until the carrier has demonstrated to the superintendent that the carrier has sufficient financial reserves to underwrite additional coverage, whichever is later.(C) The superintendent may provide for the application of this section on a service-area-specific basis.
Ohio Rev Code § 3924.033 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.033 | Information Disclosed by Carrier to Employer.

Effective: March 22, 1999|Latest Legislation:  House Bill 698 - 122nd General Assembly|(A) Each carrier, in connection with the offering of a health benefit plan to a small employer, shall disclose to the employer, as part of its solicitation and sales materials, the following information:(1) The provisions of the plan concerning the carrier's right to change premium rates and the factors that may affect changes in premium rates;(2) The provisions of the plan relating to renewability of coverage;(3) The provisions of the plan relating to any pre-existing condition exclusion;(4) The benefits and premiums available under all health benefit plans for which the employer is qualified.(B) The information described in division (A) of this section shall be provided in a manner determined to be understandable by the average small employer, and in a manner sufficient to reasonably inform a small employer regarding the employer's rights and obligations under the health benefit plan.(C) Nothing in this section requires a carrier to disclose any information that is by law proprietary and trade secret information.
Ohio Rev Code § 3924.06 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.06 | Demonstrating Compliance Through Actuarial Certification.

Effective: October 16, 2009|Latest Legislation:  House Bill 1 - 128th General Assembly|(A) Compliance with the underwriting and rating requirements contained in sections 3924.01 to 3924.14 of the Revised Code shall be demonstrated through actuarial certification. Carriers offering health benefit plans to small employers shall file annually with the superintendent of insurance an actuarial certification stating that the underwriting and rating methods of the carrier do all of the following: (1) Comply with accepted actuarial practices;(2) Are uniformly applied to health benefit plans covering small employers;(3) Comply with the applicable provisions of sections 3924.01 to 3924.14 of the Revised Code.(B) If a carrier has established a separate class of business for one or more small employer health care alliances in accordance with section 1731.09 of the Revised Code, this section shall apply in accordance with section 1731.09 of the Revised Code.(C) Carriers offering health benefit plans to small employers shall file premium rates with the superintendent in accordance with section 3923.02 of the Revised Code with respect to the carrier's sickness and accident insurance policies sold to small employers and in accordance with section 1751.12 of the Revised Code with respect to the carrier's health insuring corporation policies sold to small employers.
Ohio Rev Code § 3924.07 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.07 | [Suspended Eff. 1/1/2014 to 1/1/2022, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Ohio Health Reinsurance Program.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|(A) There is hereby established a nonprofit entity to be known as the "Ohio health reinsurance program." Any carrier issuing health benefit plans in this state on or after April 14, 1993, may be a member of the program.(B) A carrier may elect to be a member of the program by filing a written intention to participate with the superintendent of insurance at least thirty days prior to the implementation of the program. Any carrier that does not file a written intention to participate within that time period may not participate for three years after April 14, 1993, and may file an intention to participate only at that time or on any subsequent three-year anniversary date. However, the superintendent may permit a carrier to participate in the program at other intervals for reasons based on financial solvency.(C) The board of directors of the program may permit a carrier to participate in the program at any time for good cause shown. The board shall establish an application process for carriers seeking to change their status under this division. Last updated January 19, 2022 at 11:05 AM
Ohio Rev Code § 3924.10 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.10 | [Suspended Eff. 1/1/2014 to 1/1/2022, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Recommendations Regarding, Analysis and Adoption of Ohc Plans.

Effective: September 29, 2011|Latest Legislation:  House Bill 153 - 129th General Assembly|(A) The board of directors of the Ohio health reinsurance program may make recommendations to the superintendent of insurance, and the superintendent may adopt or amend by rule adopted in accordance with Chapter 119. of the Revised Code, the OHC basic, standard, and carrier reimbursement plans which, when offered by a carrier, are eligible for reinsurance under the program. The superintendent shall establish the form and level of coverage to be made available by carriers in their OHC plans. The plans shall include benefit levels, deductibles, coinsurance factors, exclusions, and limitations for the plans. The forms and levels of coverage shall specify which components of health benefit plans offered by a carrier may be reinsured. The OHC plans are subject to division (C) of section 3924.02 of the Revised Code and to the provisions in Chapters 1751., 1753., 3923., and any other chapter of the Revised Code that require coverage or the offer of coverage of a health care service or benefit.(B) Prior to adopting any rule that makes changes to the OHC basic or standard plan, the superintendent shall conduct an actuarial analysis of the cost impact of the proposed rule. The plans may include cost containment features including any of the following:(1) Utilization review of health care services, including review of the medical necessity of hospital and physician services;(2) Case management benefit alternatives;(3) Selective contracting with hospitals, physicians, and other health care providers;(4) Reasonable benefit differentials applicable to participating and nonparticipating providers;(5) Employee assistance program options that provide preventive and early intervention mental health and substance abuse services;(6) Other provisions for the cost-effective management of the plans.(C) OHC plans established for use by health insuring corporations shall be consistent with the basic method of operation of such corporations.(D) Each carrier shall certify to the superintendent of insurance, in the form and manner prescribed by the superintendent, that the OHC plans filed by the carrier are in substantial compliance with the provisions of the OHC plans designed or adopted under this section. Upon receipt by the superintendent of the certification, the carrier may use the certified plans.(E) Each carrier shall, on and after sixty days after the date that the program becomes operational and as a condition of transacting business in this state, renew coverage provided to any individual or group under its OHC plans.(F) The OHC plans in effect as of June 1, 2009, shall remain in effect until those plans are amended or new plans are adopted in accordance with this section. Last updated January 19, 2022 at 11:07 AM
Ohio Rev Code § 3924.111 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.111 | [Suspended Eff. 1/1/2014 to 1/1/2022, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Deductible Amount and Maximum Liability Amount.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|(A) The Ohio health reinsurance program shall not provide reinsurance for any individual reinsured under the program until five thousand dollars in benefit payments have been made by a member of the program for services provided to that individual during a calendar year, which payments would have been reimbursed through the program but for the five-thousand-dollar deductible. The member shall retain ten per cent of the next fifty thousand dollars of benefit payments made during that calendar year, and the program shall reinsure the remainder. However, a member's maximum liability under this section with respect to any one individual reinsured under the program shall not exceed ten thousand dollars in any one calendar year.(B) The board of directors of the Ohio health reinsurance program shall periodically review the deductible amount and the maximum liability amount set forth in division (A) of this section and, considering the rate of inflation, adjust each amount as the board considers necessary. Last updated January 19, 2022 at 11:10 AM
Ohio Rev Code § 3924.12 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.12 | [Suspended Eff. 1/1/2014 to 1/1/2022, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Premium Rates.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|(A) Except as provided in division (B) of this section, premium rates charged for coverage reinsured by the Ohio health reinsurance program shall be established as follows:(1) For whole group reinsurance coverage, one and one-half times the adjusted average market premium price established by the program for that classification or group with similar characteristics and coverage, with respect to the eligible employees of a small employer and their dependents, all of whose coverage is reinsured with the program, minus a ceding expense factor determined by the board of directors of the program;(2) For individual reinsurance coverage, five times the adjusted average market premium price established by the program for an individual in that classification or group with similar characteristics and coverage, with respect to an eligible employee or the employee's dependents, minus a ceding expense factor determined by the board.(B) Premium rates charged for reinsurance by the program to a health insuring corporation that is approved by the secretary of health and human services as a federally qualified health maintenance organization pursuant to the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended, and as such is subject to requirements that limit the amount of risk that may be ceded to the program, may be modified to reflect the portion of risk that may be ceded to the program. Last updated January 19, 2022 at 11:11 AM
Ohio Rev Code § 3924.14 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.14 | [Suspended Eff. 1/1/2014 to 1/1/2022, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Immunity.

Effective: June 30, 1997|Latest Legislation:  House Bill 374 - 122nd General Assembly|Neither the participation as members of the Ohio health reinsurance program or as members of the board of directors of the program, the establishment of rates, forms, or procedures for coverage issued by the program, nor any other joint or collective action required by sections 3924.01 to 3924.14 of the Revised Code, shall be the basis of any legal action or any criminal or civil liability or penalty against the program, the board, or any of its members either jointly or separately. Last updated January 19, 2022 at 11:12 AM
Ohio Rev Code § 3924.21 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.21 | Overcharges.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|(A) As used in this section:(1) "Beneficiary," "hospital," and "third-party payer" have the same meanings as in section 3901.38 of the Revised Code.(2) "Overcharged" means charged more than the usual and customary charge, rate, or fee that is charged by the provider or hospital for a particular item or service.(3) "Provider" has the same meaning as in section 3902.11 of the Revised Code.(B) If a beneficiary identifies on the billing statement of a provider or hospital any item or service for which the beneficiary was overcharged by more than five hundred dollars and the beneficiary notifies the third-party payer of the error at any time after the thirty-day period immediately following the date on which the third-party payer makes payment to the provider or hospital for the item or service, the provider or hospital shall refund to the beneficiary an amount equal to fifteen per cent of the amount overcharged.(C) A provider or hospital shall not be required to comply with division (B) of this section if, at the time the third-party payer receives notice of the overcharge from the beneficiary, the provider, hospital, or third-party payer is in the process of correcting the error and such process can be documented.
Ohio Rev Code § 3924.25 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage|Section 3924.25 | Prohibiting Exclusion Based on Health Condition.

Effective: November 24, 1995|Latest Legislation:  Senate Bill 150 - 121st General Assembly|(A) As used in this section, "employer" means any person who employs an individual.(B) No employer shall engage in any act or practice that, due solely to the actual or expected health condition of one or more individuals, excludes or causes the exclusion of any individual from coverage under an existing employer-provided policy, contract, or plan of health benefits for which the individual would otherwise be eligible.(C) If an employer violates division (B) of this section, the prosecuting attorney of the county in which an individual who was excluded from benefits resides may commence a civil action in the court of common pleas to obtain a judgment for a civil penalty as described in this division.If the court of common pleas determines in an action under this division that an employer violated division (B) of this section, it shall impose a civil penalty of not more than ten thousand dollars or, if the violator previously has been determined by any court of common pleas to have violated division (B) of this section, not more than twenty-five thousand dollars. Any civil penalty imposed pursuant to this division shall be deposited by the clerk of the court into the county treasury.