reglab/statecodes huggingface dataset:
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3923 | Sickness and Accident Insurance › Section 3923.851 | Prior Authorization Requirements or Other Utilization Review Measures as Conditions of Providing Coverage of an Opioid Analgesic Prescribed for Treatment of Chronic Pain; Exceptions.

Effective:
April 6, 2017
Latest Legislation:
Senate Bill 319 - 131st General Assembly
(A) As used in this section:
(1) "Benzodiazepine" has the same meaning as in section 3719.01 of the Revised Code.
(2) "Chronic pain" has the same meaning as in section 4731.052 of the Revised Code.
(3) "Hospice care program" and "hospice patient" have the same meanings as in section 3712.01 of the Revised Code.
(4) "Opioid analgesic" has the same meaning as in section 3719.01 of the Revised Code.
(5) "Prescriber" has the same meaning as in section 4729.01 of the Revised Code.
(6) "Terminal condition" means an irreversible, incurable, and untreatable condition that is caused by disease, illness, or injury and will likely result in death. A terminal condition is one in which there can be no recovery, although there may be periods of remission.
(B)(1) An individual or group policy of sickness and accident insurance or a public employee benefit plan that is delivered, issued for delivery, or renewed in this state and covers prescription drugs shall contain prior authorization requirements or other utilization review measures as conditions of providing coverage of an opioid analgesic prescribed for the treatment of chronic pain, except when the drug is prescribed under one of the following circumstances:
(a) To an individual who is a hospice patient in a hospice care program;
(b) To an individual who has been diagnosed with a terminal condition but is not a hospice patient in a hospice care program;
(c) To an individual who has cancer or another condition associated with the individual's cancer or history of cancer.
(2) When implementing division (B)(1) of this section, the sickness and accident insurer or public employee benefit plan shall consider either or both of the following, as applicable to the case in which the opioid analgesic is prescribed:
(a) If the course of treatment with the drug continues for more than ninety days, the requirements of section 4731.052 of the Revised Code;
(b) If the morphine equivalent daily dose for the drug exceeds eighty milligrams or the individual is being treated with a benzodiazepine at the time the opioid analgesic is prescribed, the guidelines established by the governor's cabinet opiate action team and presented in the document titled "Ohio Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-terminal Pain 80 mg of a Morphine Equivalent Daily Dose (MED) 'Trigger Point'" or a successor document, unless the guidelines are no longer in effect at the time the opioid analgesic is prescribed.
(C) If a sickness and accident insurer or public employee benefit plan measures the efficiency, quality of care, or clinical performance of a prescriber, including through the use of patient satisfaction surveys, it shall not penalize the prescriber, financially or otherwise, for deciding not to prescribe an opioid analgesic.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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 1/1/2026, 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 March 23, 2022 at 10:31 AM
2023 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 1/1/2026, 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 March 23, 2022 at 10:33 AM
2023 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 1/1/2026, 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 March 23, 2022 at 10:35 AM
2023 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 1/1/2026, 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 March 23, 2022 at 10:35 AM
2023 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 1/1/2026, 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 March 23, 2022 at 10:36 AM
2023 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.
2023 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.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.27 | Prohibiting Premium Increase on the Basis of Any Health Status-Related Factor.

Effective:
June 30, 1997
Latest Legislation:
House Bill 374 - 122nd General Assembly
(A) As used in this section:
(1) "Carrier," "dependent," and "health benefit plan" have the same meanings as in section 3924.01 of the Revised Code.
(2) "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.
(B) No group health benefit plan, or carrier offering health insurance coverage in connection with a group health benefit plan, shall require any individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.
(C) Nothing in division (B) of this section shall be construed to restrict the amount that an employer may be charged for coverage under a group health benefit plan, or to prevent a group health benefit plan, and a carrier offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.41 | Prohibiting Consideration of Eligibility for Medical Assistance.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) As used in sections 3924.41 and 3924.42 of the Revised Code, "health insurer" means any sickness and accident insurer or health insuring corporation. "Health insurer" also includes any group health plan as defined in section 607 of the federal "Employee Retirement Income Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1167.
(B) Notwithstanding any other provision of the Revised Code, no health insurer shall take into consideration the availability of, or eligibility for, the medicaid program in this state or in any other state when determining an individual's eligibility for coverage or when making payments to or on behalf of an enrollee, subscriber, policyholder, or certificate holder.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.42 | Prohibiting Imposing Different Requirements on Department of Job and Family Services.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
No health insurer shall impose requirements on the department of medicaid, when it has been assigned the rights of an individual who is eligible for medicaid and who is covered under a health care policy, contract, or plan issued by the health insurer, that are different from the requirements applicable to an agent or assignee of any other individual so covered.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.46 | Prohibiting Denial of Enrollment of Certain Children.

Effective:
June 30, 1994
Latest Legislation:
Senate Bill 295 - 120th General Assembly
(A) As used in sections 3924.46 to 3924.49 of the Revised Code, "health insurer" has the same meaning as in section 3924.41 of the Revised Code.
(B) No health insurer shall deny enrollment of a child under the health plan of the child's parent on the basis that any of the following applies:
(1) The child was born out of wedlock.
(2) The child is not claimed as a dependent on the federal tax return of the parent.
(3) The child does not reside in the household of the parent, or in the service area of the health insurer.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.47 | Duties of Health Insurer of Noncustodial Parent.

Effective:
July 1, 2000
Latest Legislation:
House Bill 471 - 123rd General Assembly
If a child has health care coverage through a health insurer of a noncustodial parent, the health insurer shall do all of the following:
(A) Provide such information to the custodial parent of the child as may be necessary for the child to obtain benefits through the coverage;
(B) Permit the custodial parent, or a provider with the approval of the custodial parent, to submit claims for covered services without the approval of the noncustodial parent;
(C) Make payment on claims submitted in accordance with division (B) of this section directly to the custodial parent, the provider, or the department of job and family services.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.48 | Parent Required by Court or Administrative Order to Provide Health Care Coverage for Child - Duties of Health Insurer.

Effective:
December 13, 2002
Latest Legislation:
House Bill 657 - 124th General Assembly
(A) If a parent of a child is required by a court or administrative order to provide health care coverage for the child, and if the parent is eligible for family health care coverage provided by a health insurer, the health insurer shall do both of the following:
(1) If the child is otherwise eligible for the coverage, permit the parent to enroll the child under the family coverage without regard to any enrollment period restrictions;
(2) If the parent is enrolled under the coverage but fails to make application to obtain coverage for the child, enroll the child under the family coverage upon application of the child's other parent or pursuant to a child support order containing provisions in compliance with sections 3119.29 to 3119.56 of the Revised Code.
(B) The health insurer shall not terminate the child's coverage unless the health insurer is provided satisfactory written evidence of either of the following:
(1) The court or administrative order is no longer in effect.
(2) The child is or will be enrolled under comparable health care coverage provided by another health insurer, which coverage will take effect not later than the effective date of the termination of the current coverage.
(C) As used in this section, "child support order" has the same meaning as in section 3119.01 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.49 | Parent Required by Court or Administrative Order to Provide Health Care Coverage for Child - Duties of Parent.

Effective:
December 13, 2002
Latest Legislation:
House Bill 657 - 124th General Assembly
(A) If a parent of a child is required by a court or administrative order to provide health insurance coverage for the child, which coverage is available through an employer doing business in this state, the employer shall do all of the following:
(1) If the child is otherwise eligible for the family coverage, permit the parent to enroll the child under the coverage without regard to any enrollment period restrictions;
(2) If the parent is enrolled under the coverage but fails to make application to obtain coverage for the child, enroll the child under the family coverage upon application of the child's other parent or pursuant to a child support order containing provisions in compliance with sections 3119.29 to 3119.56 of the Revised Code;
(3) Withhold from the employee's compensation the employee's share of premiums for the health care coverage, if any, and pay that amount to the health insurer providing the coverage;
(4) Comply with the requirements of sections 3119.36 to 3119.364 and 3119.42 of the Revised Code and any rules adopted by the department of job and family services under section 3119.51 of the Revised Code.
(B) The employer shall not terminate the child's coverage unless the employer has eliminated family coverage for all of its employees or unless the employer is provided satisfactory written evidence of either of the following:
(1) The court or administrative order is no longer in effect.
(2) The child is or will be enrolled under comparable health care coverage that will take effect not later than the effective date of the termination of the current coverage.
(C) As used in this section, "child support order" has the same meaning as in section 3119.01 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.51 | Plan Benefits for Adopted Children.

Effective:
June 30, 1997
Latest Legislation:
House Bill 374 - 122nd General Assembly
(A) As used in this section:
(1) "Child" means, in connection with any adoption or placement for adoption of the child, an individual who has not attained age eighteen as of the date of the adoption or placement for adoption.
(2) "Health insurer" has the same meaning as in section 3924.41 of the Revised Code.
(3) "Placement for adoption" means the assumption and retention by a person of a legal obligation for total or partial support of a child in anticipation of the adoption of the child. The child's placement with a person terminates upon the termination of that legal obligation.
(B) If an individual or group health plan of a health insurer makes coverage available for dependent children of participants or beneficiaries, the plan shall provide benefits to dependent children placed with participants or beneficiaries for adoption under the same terms and conditions as apply to the natural, dependent children of the participants and beneficiaries, irrespective of whether the adoption has become final.
(C) A health plan described in division (B) of this section shall not restrict coverage under the plan of any dependent child adopted by a participant or beneficiary, or placed with a participant or beneficiary for adoption, solely on the basis of a pre-existing condition of the child at the time that the child would otherwise become eligible for coverage under the plan, if the adoption or placement for adoption occurs while the participant or beneficiary is eligible for coverage under the plan.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.53 | Coverage for Person in Custody or Confined in Jail.

Effective:
September 6, 2002
Latest Legislation:
House Bill 170 - 124th General Assembly
(A) As used in this section:
(1) "Beneficiary" and "benefits contract" have the same meanings as in section 3901.38 of the Revised Code.
(2) "Confinement" means any period of time during which a person is in the custody or under the supervision of the department of rehabilitation and correction or is confined in a local jail, workhouse, or other correctional facility of the type described in section 307.93, 341.14, 341.19, 341.23, 753.02, 753.04, 753.16, 2301.56, or 2947.19 of the Revised Code.
(3) "Law enforcement officer" has the same meaning as in section 2901.01 of the Revised Code.
(B) Except as provided in division (C) of this section, no benefits contract shall limit or exclude coverage for the reason that the beneficiary is under confinement or is otherwise under the custody of a law enforcement officer, and a governmental entity is wholly or primarily responsible for rendering or arranging for the rendering of health care services for the beneficiary.
(C) A benefits contract may limit or exclude coverage for health care services rendered to such a beneficiary if the injury or sickness for which the services were rendered resulted from an action or omission for which the governmental entity operating the correctional facility, or the governmental entity with which the law enforcement officer is affiliated, is liable.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.61 | Medical Savings Account Definitions.

Effective:
June 30, 1997
Latest Legislation:
House Bill 374 - 122nd General Assembly
As used in sections 3924.61 to 3924.74 of the Revised Code:
(A) "Account holder" means the natural person who opens a medical savings account or on whose behalf a medical savings account is opened.
(B) "Eligible medical expense" means any expense for a service rendered by a licensed health care provider or a Christian Science practitioner, or for an article, device, or drug prescribed by a licensed health care provider or provided by a Christian Science practitioner, when intended for use in the mitigation, treatment, or prevention of disease; any amount paid for transportation to the location at which such a service is rendered; any amount paid for lodging necessitated by the receipt of care at a nonlocal hospital; or premiums paid for comprehensive sickness and accident insurance, coverage under a health care plan of a health insuring corporation organized under Chapter 1751. of the Revised Code, long-term care insurance as defined in section 3923.41 of the Revised Code, medicare supplemental coverage as defined in section 3923.33 of the Revised Code, or payments made pursuant to cost sharing agreements under comprehensive sickness and accident plans. An "eligible medical expense" does not include expenses otherwise paid or reimbursed, including medical expenses paid or reimbursed under an automobile or motor vehicle insurance policy, a workers' compensation insurance policy or plan, or an employer-sponsored health coverage policy, plan, or contract.
(C) "Dependent" has the same meaning as in section 152 of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C.A. 1, as amended.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.62 | Opening of Medical Savings Account.

Effective:
June 30, 1997
Latest Legislation:
House Bill 374 - 122nd General Assembly
(A) A medical savings account may be opened by or on behalf of any natural person, to pay the person's eligible medical expenses and the eligible medical expenses of that person's spouse or dependent. A medical savings account may be opened by or on behalf of a person only if that person participates in a sickness or accident insurance plan, a plan offered by a health insuring corporation organized under Chapter 1751. of the Revised Code, or a self-funded, employer-sponsored health benefit plan established pursuant to the "Employee Retirement Income Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended. While the medical savings account is open, the account holder shall continue to participate in such a plan.
(B) A person who refuses to participate in a policy, plan, or contract of health coverage that is funded by the person's employer, and who receives additional monetary compensation by virtue of refusing that coverage, may not open a medical savings account unless the medical savings account also is sponsored by the person's employer.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.63 | Owners of Interest in Medical Savings Account.

Effective:
June 30, 1997
Latest Legislation:
House Bill 374 - 122nd General Assembly
The owners of interest in a medical savings account are the account holder and the account holder's spouse and dependents. No medical savings account shall be subject to garnishment or attachment.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.65 | Notice of Tax Status of Deposits.

Effective:
October 1, 1996
Latest Legislation:
House Bill 179 - 121st General Assembly
Each employer that opens a medical savings account for an employee shall inform the employee, in writing at the time the account is opened, of the federal and state tax status of deposits made to the account.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3924 | Small Employer Health Benefit Plans; Provision of Health Care Coverage › Section 3924.67 | Withdrawals.

Effective:
June 30, 1997
Latest Legislation:
House Bill 374 - 122nd General Assembly
An account holder may withdraw funds from the account holder's account at any time, for any purpose. However, the administrator of a medical savings account shall not disburse funds to an account holder during the year in which the funds were deposited, except to reimburse the account holder for, or pay for, a documented eligible medical expense of the account holder or the account holder's spouse or dependent.