reglab/housing_qa huggingface dataset:
Ohio Rev Code § 1751.85 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.85 | Information for Vision Care Services or Materials.

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 health insuring corporation shall provide the information required in this division to all enrollees receiving coverage under an individual or group health insuring corporation policy, contract, or agreement providing coverage for vision care services or vision care materials. The information shall be in a conspicuous format, shall be easily accessible to enrollees, 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 provide you with an estimated cost for each service or material upon your request." (2) Disclose any business interest the health insuring corporation has in a source or supplier of vision care materials ; (3) Include an explanation that the enrollee 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 health insuring corporation provides an enrollee with information on coverage levels and out-of-pocket expenses that may be incurred by the enrollee under the policy, contract, or agreement 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 § 1751.86 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.86 | Violation Deemed Unfair and Deceptive Act or Practice.

Effective: October 1, 1998|Latest Legislation:  House Bill 361 - 122nd General Assembly|(A) No health insuring corporation shall fail to comply with sections 1751.77 to 1751.82 of the Revised Code.(B) Whoever violates division (A) of this section is deemed to have engaged in 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 § 1751.87 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.87 | Cause of Action Not Created.

Effective: December 26, 2011|Latest Legislation:  House Bill 218 - 129th General Assembly|Nothing in sections 1751.77 to 1751.83 of the Revised Code shall be construed to create a cause of action against an employer that provides health care benefits to employees through a health insuring corporation.
Ohio Rev Code § 1751.89 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.89 | Medicare and Medicaid Exceptions.

Effective: December 26, 2011|Latest Legislation:  House Bill 218 - 129th General Assembly|Sections 1751.77 to 1751.83 of the Revised Code do not apply to either of the following: (A) Coverage provided to beneficiaries enrolled in the medicare+choice program operated under Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended;(B) Coverage provided to medicaid recipients;(C) Coverage provided to participants of the children's buy-in program.
Ohio Rev Code § 1751.90 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.90 | Coverage for Teledentistry.

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 health insuring corporation policy, contract, or agreement 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 other coverage for services performed by participating and nonparticipating providers.
Ohio Rev Code § 1751.91 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.91 | Reimbursement for Pharmacists Providing Health Care.

Effective: December 16, 2020|Latest Legislation:  House Bill 203 - 133rd General Assembly|A health insuring corporation 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 health insuring corporation policy, contract, or agreement provides for payment or reimbursement of the service.
Ohio Rev Code § 1751.92 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.92 | Compliance Cost-Sharing Provisions.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|Each health insuring corporation 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 § 1753.01 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.01 | Physician-Health Plan Partnership Act Definitions.

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 section 1751.01 of the Revised Code.
Ohio Rev Code § 1753.06 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.06 | Notice of Status of the Provider's Application.

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 application. That time period may be extended by a health insuring corporation if, due to extenuating circumstances, the health insuring corporation needs additional time to consider the application and notifies the provider of the reason for the delay.
Ohio Rev Code § 1753.07 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.07 | Information Given to Provider.

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: (a) How a participating provider is reimbursed for the participating provider's services, including the range and structure of any financial risk sharing arrangements, a description of any incentive plans, and, if reimbursed according to a type of fee-for-service arrangement, the level of reimbursement for the participating provider's services;(b) Insofar as division (A)(1) of section 3963.03 of the Revised Code is applicable, all of the information that is described in that division and is not included in division (A)(1)(a) of this section.(2) Prior to entering into a participation contract with a provider under section 1751.13 of the Revised Code, a health insuring corporation shall disclose the following information upon the provider's request:(a) How referrals to other participating providers or to nonparticipating providers are made;(b) The availability of dispute resolution procedures and the potential for cost to be incurred;(c) How a participating provider's name and address will be used in marketing materials.(B) A health insuring corporation shall provide all of the following to a participating provider:(1) Any material incorporated by reference into the participation contract, that is not otherwise available as a public record, if such material affects the participating provider;(2) Administrative manuals related to provider participation, if any;(3) Insofar as division (B) of section 3963.03 of the Revised Code is applicable, the summary disclosure form with the disclosures required under that division;(4) A signed and dated copy of the final participation contract.(C) Nothing in this section requires a health insuring corporation providing specialty health care services or supplemental health care services to disclose the health insuring corporation's aggregate maximum allowable fee table used to determine providers' fees or fee schedules.
Ohio Rev Code § 1753.10 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.10 | Categories of Providers.

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 supplemental health care services, which health care services are within the recognized scope of practice of that category of provider.
Ohio Rev Code § 1753.13 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.13 | Obtaining Covered Obstetric and Gynecological Services Without Referral.

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 obstetrician or gynecologist without obtaining a referral from the enrollee's primary care provider.No individual or group health insuring corporation policy, contract, or agreement may limit the number of allowable visits to a participating obstetrician or gynecologist. A health insuring corporation may require a participating obstetrician or gynecologist to comply with the health insuring corporation's coverage protocols and procedures, including utilization review, for obstetric and gynecological services.A health insuring corporation policy, contract, or agreement may not impose additional copayments for directly accessed obstetric and gynecological services, unless the policy, contract, or agreement imposes additional copayments for direct access to any participating provider other than a primary care provider.
Ohio Rev Code § 1753.14 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.14 | Procedures for Standing Referrals to Specialists.

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 specialist if a primary care provider determines in consultation with a specialist that an enrollee needs continuing care from a specialist. The referral shall be made pursuant to a treatment plan approved by the health insuring corporation in consultation with the primary care provider, a specialist, and the enrollee. The treatment plan may limit the number of visits to the specialist, limit the period of time that the visits are authorized, or require that the specialist provide the primary care provider with regular reports on the health care provided to the enrollee.(B) A health insuring corporation shall establish and implement a procedure by which an enrollee with a condition or disease that requires specialized medical care over a prolonged period of time and is life-threatening, degenerative, or disabling may receive a referral to a specialist who has expertise in treating the condition or disease for the purpose of having the specialist coordinate the enrollee's health care. The procedure shall provide for such a referral if a primary care provider determines in consultation with the specialist that the enrollee needs the specialist's expertise. The referral shall be made pursuant to a treatment plan approved by the health insuring corporation in consultation with the primary care provider, the specialist, and the enrollee. After the referral is made, the specialist is authorized to provide health care services to the enrollee in the same manner as the enrollee's primary care provider, subject to the terms of the treatment plan.(C) The determinations described in divisions (A) and (B) of this section shall be made within three business days after a request for the determination is made by the enrollee or the enrollee's primary care provider and all appropriate medical records and other items of information necessary to make the determination have been provided.(D) Once a determination in favor of a referral is made, the referral shall be made within four business days after the determination. This time period does not apply to standing referrals involving a rare or unusual condition for which appropriate specialists are limited in number or otherwise difficult to identify.Divisions (A) and (B) of this section do not require a health insuring corporation to permit an enrollee to elect referral to a specialist who is not employed by or under contract with the health insuring corporation for the provision of health care services to the health insuring corporation's enrollees.
Ohio Rev Code § 1753.16 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.16 | Retroactively Denying Authorization.

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 this authorization if the provider renders the health care service in good faith and pursuant to the authorization and all of the terms and conditions of the provider's contract with the health insuring corporation.
Ohio Rev Code § 1753.21 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.21 | Prescription Drugs.

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 a pharmacy and therapeutics committee, a majority of the members of which are physicians affiliated with the health insuring corporation who may prescribe prescription drugs and pharmacists affiliated with the health insuring corporation; or in consultation with and with the approval of a pharmacy and therapeutics committee that is independent of the health insuring corporation consisting of physicians who may prescribe prescription drugs in their state of licensure and pharmacists who are authorized to practice in their state of licensure;(2) Establish a procedure by which an enrollee may obtain, without penalty or additional cost sharing beyond that provided for formulary drugs under the enrollee's contract with the health insuring corporation, coverage of a specific nonformulary drug when the prescriber documents in the enrollee's medical record and certifies that the formulary alternative has been ineffective in the treatment of the enrollee's disease or condition, or that the formulary alternative causes or is reasonably expected by the prescriber to cause a harmful or adverse reaction in the enrollee.(B) Nothing in this section shall be construed to require a health insuring corporation to place any particular pharmaceutical product or therapeutic class of product on any formulary, or to prohibit a health insuring corporation from restricting payments for any specific pharmaceutical product or therapeutic class of product, including, but not limited to, a requirement that the product be prescribed only by a defined specialist or subspecialist.
Ohio Rev Code § 1753.23 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.23 | Internal Technology Assessment Process.

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 condition when compared to alternative therapies, or whether it remains experimental or investigational. The health insuring corporation's internal technology assessment process shall meet all of the following criteria:(A) Decisions are made by medical professionals, including physicians.(B) The process includes a review of relevant medical evidence, including the following, if available:(1) Peer-reviewed medical and scientific literature on the subject;(2) Published opinions, actions, and other relevant documents of independent, external research organizations such as the national institute of health, the national cancer institute, the United States food and drug administration, the health care finance administration, and the agency for health care policy and research;(3) Published opinions of medical experts or affected specialty societies.(C) General coverage decisions, made pursuant to this process, that exclude drugs, devices, protocols, procedures, or other therapies on the basis that they are not safe or efficacious and remain experimental or investigational, are reviewed and updated as new scientific evidence becomes available.(D) A description of the health insuring corporation's internal technology assessment process is made available to participating providers and enrollees, upon request.(E) A copy of the health insuring corporation's specific coverage protocols and procedures is made available to participating providers and enrollees upon the request of an enrollee who has been denied coverage for a drug, device, protocol, procedure, or other therapy on the basis that it has been assessed as not being safe or efficacious for a particular indication or condition. Specific coverage protocols and procedures shall include a description of the evidence upon which the protocol or procedure is based, and shall contain the date the protocol or procedure was adopted.(F) A drug or device that has received full market approval by the United States food and drug administration for treatment of a particular indication or condition cannot, for purposes of this assessment process, be considered experimental or investigational for that indication or condition.
Ohio Rev Code § 1753.30 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1753 | Physician-Health Plan Partnership Act; Risk-Based Capital for Insurers Model Act|Section 1753.30 | Other Insurance Provisions.

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.