reglab/statecodes huggingface dataset:
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.388 | Payments Considered Final - Overpayment.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
(A) A payment made by a third-party payer to a provider in accordance with sections 3901.381 to 3901.386 of the Revised Code shall be considered final two years after payment is made. After that date, the amount of the payment is not subject to adjustment, except in the case of fraud by the provider.
(B) A third-party payer may recover the amount of any part of a payment that the third-party payer determines to be an overpayment if the recovery process is initiated not later than two years after the payment was made to the provider. The third-party payer shall inform the provider of its determination of overpayment by providing notice in accordance with division (C) of this section. The third-party payer shall give the provider an opportunity to appeal the determination. If the provider fails to respond to the notice sooner than thirty days after the notice is made, elects not to appeal the determination, or appeals the determination but the appeal is not upheld, the third-party payer may initiate recovery of the overpayment.
When a provider has failed to make a timely response to the notice of the third-party payer's determination of overpayment, the third-party payer may recover the overpayment by deducting the amount of the overpayment from other payments the third-party payer owes the provider or by taking action pursuant to any other remedy available under the Revised Code. When a provider elects not to appeal a determination of overpayment or appeals the determination but the appeal is not upheld, the third-party payer shall permit a provider to repay the amount by making one or more direct payments to the third-party payer or by having the amount deducted from other payments the third-party payer owes the provider.
(C) The notice of overpayment a third-party payer is required to give a provider under division (B) of this section shall be made in writing and shall specify all of the following:
(1) The full name of the beneficiary who received the health care services for which overpayment was made;
(2) The date or dates the services were provided;
(3) The amount of the overpayment;
(4) The claim number or other pertinent numbers;
(5) A detailed explanation of basis for the third-party payer's determination of overpayment;
(6) The method in which payment was made, including, for tracking purposes, the date of payment and, if applicable, the check number;
(7) That the provider may appeal the third-party payer's determination of overpayment, if the provider responds to the notice within thirty days;
(8) The method by which recovery of the overpayment would be made, if recovery proceeds under division (B) of this section.
(D) Any provision of a contractual arrangement entered into between a third-party payer and a provider or beneficiary that is contrary to divisions (A) to (C) of this section is unenforceable.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.389 | Computation of Interest.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
(A) Any third-party payer that fails to comply with section 3901.381 of the Revised Code, or any contractual payment arrangement entered into under section 3901.383 of the Revised Code, shall pay interest in accordance with this section.
(B) Interest shall be computed based upon the number of days that have elapsed between the date payment is due in accordance with section 3901.381 of the Revised Code or the contractual payment arrangement entered into under section 3901.383 of the Revised Code, and the date payment is made. The interest rate for determining the amount of interest due shall be equal to an annual percentage rate of eighteen per cent.
(C) For purposes of this section, if a dispute exists between a provider and a third-party payer as to the day a payment was made by the third-party payer, both of the following apply:
(1) If the third-party payer or a person acting on behalf of the third-party payer submits a payment directly to a provider by mail and retains a record of the day the payment was mailed, there exists a rebuttable presumption that the payment was made five business days before the day the payment was received by the provider, unless it can be proven otherwise.
(2) If the third-party payer or a person acting on behalf of the third-party payer submits a payment directly to a provider electronically, there exists a rebuttable presumption that the payment was made twenty-four hours before the date the payment was received by the provider, unless it can be proven otherwise.
(D) Interest due in accordance with this section shall be paid directly to the provider at the time payment of the claim is made and shall not be used to reduce benefits or payments otherwise payable under a benefits contract.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.3810 | Complaints by Provider or Beneficiary - Retaliation by Payer.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
(A) A provider or beneficiary aggrieved with respect to any act of a third-party payer that the provider or beneficiary believes to be a violation of sections 3901.381 to 3901.388 of the Revised Code may file a written complaint with the superintendent of insurance regarding the violation.
(B) A third-party payer shall not retaliate against a provider or beneficiary who files a complaint under division (A) of this section. If a provider or beneficiary is aggrieved with respect to any act of the third-party payer that the provider or beneficiary believes to be retaliation for filing a complaint under division (A) of this section, the provider or beneficiary may file a written complaint with the superintendent regarding the alleged retaliation.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.3811 | Failure to Comply by Third-Party Payer.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
(A) No third-party payer shall fail to comply with sections 3901.381 and 3901.384 to 3901.3810 of the Revised Code.
(B) The superintendent of insurance may require third-party payers to submit reports of their compliance with division (A) of this section. If reports are required, the superintendent shall prescribe the content, format, and frequency of the reports in consultation with third-party payers. The superintendent shall not require reports to be submitted more frequently than once every three months.
The superintendent shall not use findings from reports submitted by a third-party payer under this division as the basis of a finding of a violation of division (A) of this section or the imposition of penalties under section 3901.3812 of the Revised Code. However, the information contained in the reports may cause the superintendent to conduct a market conduct examination of the third-party payer. During this examination, the superintendent may examine data collected from the same time period as covered by these reports and the superintendent's examination findings may be used as the basis for finding a violation of division (A) of this section.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.3813 | Rules.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
The superintendent of insurance may adopt rules as the superintendent considers necessary to carry out the purposes of section 3901.38 and sections 3901.381 to 3901.3812 of the Revised Code. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.3814 | Exceptions to Provisions.

Effective:
October 17, 2019
Latest Legislation:
House Bill 166 - 133rd General Assembly
Sections 3901.38 and 3901.381 to 3901.3813 of the Revised Code do not apply to the following:
(A) Policies offering coverage that is regulated under Chapters 3935. and 3937. of the Revised Code;
(B) An employer's self-insurance plan and any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of any provisions of those sections to the plan and its administrators;
(C) A third-party payer for coverage provided under the medicare advantage program operated under Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, as amended;
(D) A third-party payer for coverage provided under the medicaid program;
(E) A third-party payer for coverage provided under the tricare program offered by the United States department of defense.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.40 | Payment or Reimbursement to Unlicensed or Unaccredited Hospital Prohibited.

Effective:
June 4, 1997
Latest Legislation:
Senate Bill 67 - 122nd General Assembly
No insurance company, health insuring corporation, or self-insurance plan authorized to do business in this state shall include or provide in its policies or subscriber agreements for benefit payments or reimbursement for services in any hospital which is not certified or accredited as provided in division (A) of section 3727.02 of the Revised Code. No hospital located in this state shall charge any insurance company, health insuring corporation, federal, state, or local government agency, or person for any services rendered unless the hospital is certified or accredited as provided in division (A) of section 3727.02 of the Revised Code. "Hospital" as used in this section means only those institutions included within the definition of that term contained in section 3727.01 of the Revised Code, and the prohibitions in this section do not apply to facilities excluded from that definition.
Last updated July 23, 2021 at 8:13 AM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.42 | Annual Filing With National Association of Insurance Commissioners.

Effective:
June 18, 1986
Latest Legislation:
House Bill 464 - 116th General Assembly
(A) As used in this section, "actuarial certification" means certification by a member in good standing of the American academy of actuaries, or a person who otherwise has competency in loss reserve valuation.
(B) Each domestic, foreign, and alien insurer authorized to transact insurance in this state shall, annually on or before the first day of March of each year, file with the national association of insurance commissioners a copy of its annual statement convention blank, along with such additional filings as prescribed by the superintendent of insurance for the preceding year. The information filed with the association shall be in the same format and scope as that required by the superintendent and shall include the signed jurat page and the actuarial certification, as required by the state of domicile. Any amendments and addendums to the annual statement filing subsequently filed with the superintendent shall also be filed with the association.
(C) Foreign insurers that are domiciled in a state that has a law substantially similar to division (B) of this section are deemed in compliance with this section.
(D) In the absence of actual malice, members, delegates, and employees of the national association of insurance commissioners, its authorized committees, subcommittees, and task forces, and all others charged with the responsibility of collecting, reviewing, analyzing, and disseminating the information developed from the filing of the annual statement convention blanks shall be acting as agents of the superintendent under the authority of this section and are not subject to civil liability for libel, slander, or any other cause of action by virtue of their collection, review, and analysis or dissemination of the data and information collected from the filings required under this section.
(E)(1) In addition to the annual statement required to be filed with the national association of insurance commissioners under division (B) of this section, the superintendent may require an insurer to file with the superintendent, on or before the forty-fifth day following the last day of each calendar quarter, quarterly reports showing its condition for each of the first three calendar quarters.
(2) The quarterly report shall consist of information that the superintendent considers to be relevant to the determination of the solvency of an insurer.
(F) The superintendent may, pursuant to Chapter 119. of the Revised Code, suspend, revoke, or refuse to renew the license to engage in the business of insurance of any insurer that fails to file its annual statement within the time required under division (B) of this section or a quarterly report within the time required under division (E) of this section, or within any extension of time which the superintendent, for good cause, may have granted.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.491 | Genetic Screening or Testing.

Effective:
April 6, 2023
Latest Legislation:
House Bill 281 - 134th General Assembly
(A) As used in this section:
(1) "Genetic screening or testing" means a laboratory test of a person's genes or chromosomes forgenotypes, mutations, or chromosomal changes, including carrier status, that are linked to physical or mental disorders or impairments, or that indicate a susceptibility to illness, disease, or other disorders, whether physical or mental, which test is a direct test for genotypes, mutations, or chromosomal changes, and not an indirect manifestation of genetic disorders.
(2) "Insurer" means any person authorized under Title XXXIX of the Revised Code to engage in the business of sickness and accident insurance.
(3) "Sickness and accident insurance" means sickness and accident insurance under Chapter 3923. of the Revised Code excluding disability income insurance and excluding supplemental policies of sickness and accident insurance.
(B) No insurer or public employee benefit plan shall do either of the following:
(1) Consider any information obtained from genetic screening or testing in processing an application for an individual or group policy of sickness and accident insurance or public employee benefit plan, or in determining insurability under such a policy or plan;
(2) Inquire, directly or indirectly, into the results of genetic screening or testing or use such information, in whole or in part, to cancel, refuse to issue or renew, limit benefits under, or set premiums for a sickness and accident insurance policy or public employee benefit plan.
(C) Any insurer or plan that has engaged in, is engaged in, or is about to engage in a violation of division (B) of this section is subject to the jurisdiction of the superintendent of insurance under section 3901.04 of the Revised Code.
Last updated March 10, 2023 at 12:24 PM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.501 | Genetic Screening or Testing for Self-Insurance Plans.

Effective:
April 6, 2023
Latest Legislation:
House Bill 281 - 134th General Assembly
(A) As used in this section:
(1) "Genetic screening or testing" means a laboratory test of a person's genes or chromosomes for genotypes, mutations, or chromosomal changes, including carrier status, that are linked to physical or mental disorders or impairments, or that indicate a susceptibility to illness, disease, or other disorders, whether physical or mental, which test is a direct test for genotypes, mutations, or chromosomal changes, and not an indirect manifestation of genetic disorders.
(2) "Self-insurer" means any government entity providing coverage for health care services on a self-insurance basis.
(B) Upon the repeal of section 3901.50 of the Revised Code, no self-insurer shall do either of the following:
(1) Consider any information obtained from genetic screening or testing in processing an application for coverage under a plan of self-insurance or in determining insurability under such a plan;
(2) Inquire, directly or indirectly, into the results of genetic screening or testing or use such information, in whole or in part, to cancel, refuse to provide or renew, or limit benefits under, a plan of self-insurance.
(C) Any self-insurer that has engaged in, is engaged in, or is about to engage in a violation of division (B) of this section is subject to the jurisdiction of the superintendent of insurance under section 3901.04 of the Revised Code.
Last updated March 10, 2023 at 12:25 PM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.51 | Uncertified Securities as Deposits Definitions.

Effective:
August 6, 2004
Latest Legislation:
House Bill 243 - 125th General Assembly
As used in sections 3901.51 to 3901.55 of the Revised Code:
(A) "Clearing corporation" has the same meaning as in section 1308.01 of the Revised Code, except that with respect to securities issued by institutions organized or existing under the laws of any foreign country or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business in that country, "clearing corporation" includes a corporation that is organized or existing under the laws of any foreign country and is legally qualified under those laws to effect transactions in securities by computerized book-entry.
(B) "Direct participant" means a bank, trust company, or other entity that maintains an account in its name in a clearing corporation and through which an insurance company participates in a clearing corporation.
(C) "Federal reserve book-entry system" means the computerized systems sponsored by the United States department of the treasury and agencies and instrumentalities of the United States for holding and transferring securities of the United States government and agencies and instrumentalities in federal reserve banks through banks that are members of the federal reserve system or that otherwise have access to these computerized systems.
(D) "Member bank" means a national or state bank or a trust company that is a member of the federal reserve system and through which an insurance company participates in the federal reserve book-entry system.
(E) "Provisions of the insurance laws of this state" means provisions of Title XXXIX of the Revised Code related to the deposit of securities for the benefit and security of policyholders, and includes, but is not limited to, sections 3901.18, 3901.74, 3901.75, 3901.86, 3903.73, 3907.07, 3909.03, 3909.09, 3909.17, 3913.01, 3913.04, 3919.13, 3919.36, 3919.37, 3919.41, 3925.07, 3927.02, 3927.06, 3929.01, 3929.07, 3929.08, 3929.09, 3929.10, 3929.11, 3941.30, 3941.31, 3941.32, 3941.33, 3941.34, 3941.42, 3953.06, and 3953.11 of the Revised Code.
(F) "Securities" has the same meaning as in section 1308.01 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.52 | Insurance Company May Place Securities in Clearing Corporation or Federal Reserve Book-Entry System.

Effective:
September 28, 1990
Latest Legislation:
House Bill 629 - 118th General Assembly
(A) An insurance company may place or arrange for the placement of securities held in or purchased for its general account and its separate accounts in a clearing corporation or the federal reserve book-entry system. Ownership of, and other interest in, these securities may be transferred by bookkeeping entry on the books of the clearing corporation or in the federal reserve book-entry system without physical delivery of certificates representing these securities.
(B) The records of any member bank through which an insurance company holds securities in the federal reserve book-entry system, and the records of any direct participant through which an insurance company holds securities in a clearing corporation, shall show at all times that the securities are held for that insurance company and for which accounts of that insurance company they are held.
(C) When securities are placed with a clearing corporation, certificates representing securities of the same class of the same issuer may be merged and held in bulk in the name of the nominee of the clearing corporation with any other securities placed with the clearing corporation by any person regardless of the ownership of the securities, and certificates representing securities of small denominations may be merged into one or more certificates of larger denominations.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.53 | Placement of Securities Shall Satisfy Deposit Requirements.

Effective:
September 28, 1990
Latest Legislation:
House Bill 629 - 118th General Assembly
(A) Securities that are eligible for deposit under provisions of the insurance laws of this state may be placed with a clearing corporation or held in the federal reserve book-entry system.
(B) When an insurance company places or arranges for the placement of securities in a clearing corporation or in the federal reserve book-entry system, the securities so placed shall satisfy the deposit requirements under provisions of the insurance laws of this state, if all of the following conditions are satisfied:
(1) The securities shall be under the control of the superintendent of insurance;
(2) The securities shall not be withdrawn by the insurance company without the written approval of the superintendent;
(3) The placement shall be made pursuant to a written agreement between the insurance company and a direct participant or member bank. The agreement shall be approved in writing by the superintendent and shall limit withdrawals to those having the written approval of the department of insurance.
(4) The placement shall be credited by the department as a deposit in its possession on the basis of an affidavit of the insurance company describing the amount and nature of the securities;
(5) The insurance company holding the securities shall provide the superintendent with both of the following:
(a) Evidence issued by its direct participant or the member bank through which it has placed securities in a clearing corporation or in the federal reserve book-entry system. The evidence shall be in a form that is sufficient to establish that the securities are actually recorded in an account in the name of the direct participant or member bank.
(b) Evidence issued by its direct participant or the member bank that the records of the direct participant or member bank reflect that the securities are held subject to the written order of the superintendent.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.54 | Securities May Not Be Used for Other Purposes.

Effective:
September 28, 1990
Latest Legislation:
House Bill 629 - 118th General Assembly
No insurance company shall use, for any purpose other than to satisfy the deposit requirements under provisions of the insurance laws of this state, securities that have been placed in a clearing corporation or in the federal reserve book-entry system for the satisfaction of these requirements pursuant to division (B) of section 3901.53 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.55 | Rules.

Effective:
September 28, 1990
Latest Legislation:
House Bill 629 - 118th General Assembly
The superintendent of insurance may adopt rules pursuant to Chapter 119. of the Revised Code to carry out the purposes of sections 3901.51, 3901.52, and 3901.53 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.56 | Rewards or Incentives for Insurer Wellness or Health Improvement Programs.

Effective:
September 29, 2011
Latest Legislation:
House Bill 153 - 129th General Assembly
An insurer may offer a wellness or health improvement program that provides rewards or incentives, including merchandise; gift cards; debit cards; premium discounts or rebates; contributions to a health savings account; modifications to copayment, deductible, or coinsurance amounts; or any combination of these incentives, to encourage participation or to reward participation in the program.
A wellness or health improvement program offered by an insurer under this section shall not be construed to violate division (E) of section 1751.31 or division (G) of section 3901.21 of the Revised Code if the program is disclosed in the policy or plan.
The insured may be required to provide verification, such as a statement from their physician, that a medical condition makes it unreasonably difficult or medically inadvisable for the individual to participate in the wellness or health improvement program.
Nothing in this section shall prohibit an insurer from offering incentives or rewards to members for adherence to wellness or health improvement programs if otherwise allowed by federal law.
Nothing under division (C)(1) of section 3923.571 or section 3924.25 of the Revised Code shall be construed as prohibiting an insurer from offering a wellness or health improvement program or restricting the amount an employee is charged for coverage under a group policy after the application of any premium discounts or rebates, or modifying otherwise applicable copayments or deductibles for adherence to wellness or health improvement programs.
For purposes of this section, "insurer" means a life insurance company, sickness and accident insurer, multiple employer welfare arrangement, public employee benefit plan, or health insuring corporation.
Last updated February 9, 2022 at 3:03 PM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.61 | Credit for Reinsurance Ceded Definitions.

Effective:
June 29, 1994
Latest Legislation:
House Bill 89 - 120th General Assembly
As used in sections 3901.61 to 3901.65 of te Revised Code:
(A) "Assuming insurer" means an insurance company that accepts all or part of the risk underwritten by a ceding insurer.
(B) "Ceding insurer" means an insurance company that transfers all or part of the risk it underwrites to an assuming insurer.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.621 | Suspension or Revocation of Reinsurer's Accreditation or Certification.

Effective:
September 4, 2014
Latest Legislation:
Senate Bill 140 - 130th General Assembly
(A) If a reinsurer accredited pursuant to division (B)(1) of section 3901.62 of the Revised Code or certified pursuant to division (D)(1) of that section ceases to meet the requirements for accreditation or certification, the superintendent may suspend or revoke the reinsurer's accreditation or certification after a hearing held pursuant to Chapter 119. of the Revised Code. The suspension or revocation shall not take effect until after the superintendent's order or hearing, unless one of the following applies:
(1) The reinsurer waives its right to a hearing.
(2) The superintendent's order is based on regulatory action by the reinsurer's domiciliary jurisdiction or the voluntary surrender or termination of the reinsurer's eligibility to transact insurance or reinsurance business in its domiciliary jurisdiction or in the primary certifying state of the reinsurer under division (D)(6) of section 3901.62 of the Revised Code.
(3) The superintendent finds that an emergency requires immediate action, and a court of competent jurisdiction has not stayed the superintendent's action.
(B) While a reinsurer's accreditation or certification is suspended, no reinsurance contract issued or renewed after the effective date of the suspension qualifies for credit except to the extent that the reinsurer's obligations under the contract are secured in accordance with section 3901.63 of the Revised Code.
(C) If the superintendent revokes a reinsurer's accreditation or certification, no credit for reinsurance may be granted under section 3901.62 or 3901.63 of the Revised Code after the effective date of the revocation except to the extent that the reinsurer's obligations under the contract are secured in accordance with division (D)(5) of section 3901.62 or section 3901.63 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.631 | Management of Reinsurance Recoverables by Domestic Ceding Insurer.

Effective:
September 4, 2014
Latest Legislation:
Senate Bill 140 - 130th General Assembly
(A) A domestic ceding insurer shall take steps to manage its reinsurance recoverables proportionate to its own book of business.
(1) A domestic ceding insurer shall notify the superintendent within thirty days after reinsurance recoverables from any single assuming insurer, or group of affiliated assuming insurers, exceed fifty per cent of the domestic ceding insurer's last reported surplus to policyholders, or after it has determined that reinsurance recoverables from any single assuming insurer, or group of affiliated assuming insurers, are likely to exceed this limit.
(2) The notification required in division (A)(1) of this section shall demonstrate that the exposure is safely managed by the domestic ceding insurer.
(B) A domestic ceding insurer shall take steps to diversify its reinsurance program.
(1) A domestic ceding insurer shall notify the superintendent within thirty days after ceding to any single assuming insurer, or group of affiliated assuming insurers, more than twenty per cent of the ceding insurer's gross written premium in the prior calendar year, or after it has determined that the reinsurance ceded to any single assuming insurer, or group of affiliated assuming insurers, is likely to exceed this limit.
(2) The notification required in division (B)(1) of this section shall demonstrate that the exposure is safely managed by the domestic ceding insurer.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.65 | Rules.

Effective:
June 29, 1994
Latest Legislation:
House Bill 89 - 120th General Assembly
The superintendent of insurance may adopt rules, in accordance with Chapter 119. of the Revised Code, to carry out the purposes of sections 3901.61 to 3901.65 of the Revised Code, including a rule regarding the standards of acceptability of letters of credit and other forms of security for purposes of division (C) of section 3901.63 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.67 | Disclosure of Material Transactions Model Act Definitions.

Effective:
March 3, 1996
Latest Legislation:
House Bill 374 - 121st General Assembly
As used in sections 3901.67 to 3901.70 of the Revised Code:
(A) "Material acquisition" means an acquisition, or a series of related acquisitions during any thirty-day period, that is nonrecurring and not in the ordinary course of business and involves more than five per cent of the reporting insurer's total admitted assets as reported in its most recent statutory financial statement filed with the department of insurance.
(B) "Material disposition" means a disposition, or a series of related dispositions during any thirty-day period, that is nonrecurring and not in the ordinary course of business and involves more than five per cent of the reporting insurer's total admitted assets as reported in its most recent statutory financial statement filed with the department of insurance.
(C) "Material nonrenewal, cancellation, or revision of ceded reinsurance agreements" means a nonrenewal, cancellation, or revision of ceded insurance that affects more than fifty per cent of an insurer's ceded written premium, or more than fifty per cent of an insurer's total ceded indemnity and loss adjustment reserves, for property and casualty business, including accident and health business when written as such. "Material nonrenewal, cancellation, or revision of ceded reinsurance agreements" also means a nonrenewal, cancellation, or revision of ceded insurance that affects more than fifty per cent of the total reserve credit taken for business ceded for life, annuity, and accident and health business, where the ceded written premium or total reserve credit taken is calculated on an annualized basis as indicated in the insurer's most recently filed statutory financial statement.
A nonrenewal, cancellation, or revision of ceded insurance is not material for property and casualty business, including accident and health business when written as such, if the insurer's total ceded written premium represents, on an annualized basis, less than ten per cent of its total written premium for direct and assumed business. A nonrenewal, cancellation, or revision of ceded insurance is not material for life, annuity, and accident and health business, if the total reserve credit taken for business ceded represents less than ten per cent of the statutory reserve requirements prior to any cession.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.68 | Provisions Application.

Effective:
March 3, 1996
Latest Legislation:
House Bill 374 - 121st General Assembly
Sections 3901.67 to 3901.70 of the Revised Code apply to all of the following:
(A) Asset acquisitions, including every purchase, lease, exchange, merger, consolidation, succession, or other acquisition other than the construction or development of real property by or for the reporting insurer, or the acquisition of materials for such purpose.
(B) Asset dispositions, including every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment whether for the benefit of creditors or otherwise, abandonment, destruction, or other disposition.
(C) Nonrenewals, cancellations, or revisions of ceded reinsurance, without regard to which party has initiated the transaction, whenever one or more of the following conditions exists:
(1) The entire cession has been canceled, and nonrenewed or revised and ceded indemnity and loss adjustment expense reserves after any nonrenewal, cancellation, or revision represents less than fifty per cent of the comparable reserves that would have been ceded had the nonrenewal, cancellation, or revision not occurred.
(2) An authorized reinsurer has been replaced on an existing cession by an unauthorized reinsurer, and the revision affects more than ten per cent of the cession.
(3) Collateral requirements previously established for unauthorized reinsurers have been reduced, and the revision affects more than ten per cent of the cession.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.71 | Application of Mandated Health Benefits.

Effective:
November 24, 1995
Latest Legislation:
Senate Bill 150 - 121st General Assembly
(A) As used in this section, "mandated health benefits" means any required coverage, or required offering of coverage, for the expenses of specified services, treatments, or diseases under any policy, contract, plan, or other arrangement providing sickness and accident or other health benefits to policyholders, subscribers, or members.
(B) Any provision for mandated health benefits contained in a law enacted by the general assembly after January 14, 1993, shall not be applied to any policy, contract, plan, or other arrangement providing sickness and accident or other health benefits until the superintendent of insurance determines, pursuant to a hearing conducted in accordance with Chapter 119. of the Revised Code, that the provision can be applied fully and equally in all respects to employee benefit plans subject to regulation by the federal "Employee Retirement Income Security Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended, and to employee benefit plans established or modified by the state or any political subdivision of the state, or by any agency or instrumentality of the state or any political subdivision of the state.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.72 | Money Advanced to Insurance Company or Health Insuring Corporation.

Effective:
September 26, 2003
Latest Legislation:
House Bill 95 - 125th General Assembly
Any person may advance to a domestic insurance company or a health insuring corporation any sum of money necessary for the purpose of the insurance company's or health insuring corporation's business, or to enable the insurance company or health insuring corporation to comply with any law, or as a cash guarantee fund. Such money, and interest agreed upon, shall not be a liability or claim against the insurance company or health insuring corporation, or any of its assets, except as provided in this section, and shall be repaid only out of the surplus earnings of such insurance company or health insuring corporation. Except as ordered by the superintendent of insurance, no part of the principal or interest thereof shall be repaid until the surplus of the insurance company or health insuring corporation remaining after such repayment is equal in amount to the principal of the money so advanced. Such advancement and repayment shall be subject to the approval of the superintendent, provided that this section shall not affect the power to borrow money which any such insurance company or health insuring corporation possesses under other laws. No commission or promotion expenses shall be paid by the insurance company or health insuring corporation, in connection with the advance of any such money to the insurance company or health insuring corporation, and the amount of any such unpaid advance shall be reported in each annual statement.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.73 | Department to Forward Copy of Late Filing Notice to Board of Directors.

Effective:
June 18, 2002
Latest Legislation:
Senate Bill 171 - 124th General Assembly
The department of insurance shall forward a copy of any written notice received from any insurance company or health insuring corporation domiciled in this state that the insurer or health insuring corporation will be late in making the filing of any quarterly or annual financial statement, required under Title XXXIX or Chapter 1751. of the Revised Code, to the board of directors of the insurer or health insuring corporation required to file the financial statement. The department shall also provide the board the date on which the department received the notice.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.74 | Notice of Life Insurance Company Discontinuing Business.

Effective:
September 1, 2002
Latest Legislation:
Senate Bill 129 - 124th General Assembly
When a life insurance company doing business in this state decides to discontinue its business, the superintendent of insurance upon the application of the company or association shall give notice, at its expense, of such intention at least once a week for six weeks in a newspaper published and of general circulation in the county in which the company or its general agency is located. After such publication, the superintendent shall deliver to the company or association its securities held by the superintendent, if the superintendent is satisfied on an exhibition of its books and papers, and on an examination made by the superintendent or by some competent, disinterested person appointed by the superintendent, and upon the oath of the president or principal officer and the secretary or actuary of the company, that all debts and liabilities due or to become due upon any contract or agreement made with any citizen or resident of the United States are paid and extinguished. The superintendent may deliver to the company or association or its assigns any portion of the securities on being satisfied that an equal proportion of the debts and liabilities due or to become due upon any such contract or agreement have been satisfied, if the amount of securities retained by the superintendent is not less than twice the amount of the remaining liabilities.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.75 | Notice of Insurance Companies Other Than Life Discontinuing Business.

Effective:
September 1, 2002
Latest Legislation:
Senate Bill 129 - 124th General Assembly
When any insurance company or corporation other than life, which company or corporation has made a deposit with the superintendent of insurance, intends to discontinue its business in this state, the superintendent, upon the application of the company or corporation, shall give notice at its expense of such intention at least once a week for six weeks in three newspapers of general circulation in the state.
After such publication, the superintendent shall deliver to the company or association its securities held by the superintendent, if the superintendent is satisfied by the affidavits of the principal officers of the company, and on an examination made by the superintendent or by some competent, disinterested person appointed by the superintendent if the superintendent deems it necessary, that all liabilities and obligations which the deposit has been made to secure have been paid and extinguished. The superintendent may deliver to the company or its assigns, under like condition, any portion of the securities on being satisfied that an equal proportion of the liabilities and obligations have been satisfied, if the amount of securities retained by the superintendent is not less than twice the amount of the remaining liabilities and obligations.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.77 | Forms, Instructions, Manuals - Determination of Accounting Practices and Methods.

Effective:
September 1, 2002
Latest Legislation:
Senate Bill 129, Senate Bill 171 - 124th General Assembly
(A) The superintendent of insurance shall adopt the forms, instructions, and manuals prescribed by the national association of insurance commissioners, for the preparation and filing of statutory financial statements and other financial information. However, the superintendent may by rule adopt modifications to the prescribed forms, instructions, and manuals as the superintendent considers necessary.
(B) For circumstances not addressed by the forms, instructions, and manuals prescribed by the national association of insurance commissioners, the superintendent may determine accounting practices and methods for purposes of preparing statutory financial statements and other financial information.
(C) The superintendent shall furnish each domestic insurance company the forms for the filing of statutory financial statements and other financial information required to be made by it.
The Legislative Service Commission presents the text of this section as a composite of the section as amended by multiple acts of the General Assembly. This presentation recognizes the principle stated in R.C. 1.52(B) that amendments are to be harmonized if reasonably capable of simultaneous operation.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.78 | Certificate of Compliance.

Effective:
September 29, 2005
Latest Legislation:
House Bill 66 - 126th General Assembly
Upon request or in any other circumstance that the superintendent of insurance determines to be appropriate, the superintendent may issue certificates of compliance to insurance companies and associations authorized to do business in this state, which shall be on either forms established by the national association of insurance commissioners or on such other forms as the superintendent may prescribe.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.80 | Discriminating Against Living Organ Donors.

Effective:
July 6, 2022
Latest Legislation:
House Bill 188 - 134th General Assembly
(A) As used in this section:
(1) "Living organ donor" means a living person who donates an organ to another living person.
(2) "Policy of insurance" means a life insurance policy, disability insurance policy, or long-term care insurance policy.
(B) Notwithstanding any provision of law to the contrary, an insurer shall not unfairly discriminate against a living organ donor in the offering, issuance, premium, or conditions of a policy of insurance based solely, and without any additional actuarial risks, on that person's status as a living organ donor.
(C) A violation of division (B) of this section shall be considered an unfair and deceptive practice in the business of insurance under section 3901.21 of the Revised Code.
(D) The superintendent of insurance may adopt rules as necessary to carry out the requirements of this section.
Last updated May 5, 2022 at 12:14 PM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.81 | Definitions.

Effective:
March 23, 2015
Latest Legislation:
Senate Bill 258 - 130th General Assembly
As used in this section and sections 3901.811 to 3901.815 of the Revised Code:
(A) "Auditing entity" means any person or government entity that performs a pharmacy audit, including a payer, a pharmacy benefit manager, or a third-party administrator licensed under Chapter 3959. of the Revised Code.
(B) "Business day" means any day of the week excluding Saturday, Sunday, and a legal holiday, as defined in section 1.14 of the Revised Code.
(C) "Concurrent review" means a claims review within five business days of submission of claims for payment for the provision of dangerous drugs for which the payer or the auditing entity does not impose a penalty or demand to recoup money from the pharmacy in any amount.
(D) "Dangerous drug," "pharmacy," "practice of pharmacy," and "prescription" have the same meanings as in section 4729.01 of the Revised Code.
(E) "Payer" means any of the following that pays for or processes a claim for payment for the provision of dangerous drugs or pharmacy services:
(1) A health insuring corporation, as defined in section 1751.01 of the Revised Code;
(2) A person authorized to engage in the business of sickness and accident insurance under Title XXXIX of the Revised Code;
(3) A person or government entity providing coverage of dangerous drugs or pharmacy services to individuals on a self-insurance basis;
(4) A group health plan, as defined in 29 U.S.C. 1167;
(5) A service benefit plan, as referenced in 42 U.S.C. 1396a(a)(25);
(6) A medicaid managed care organization that has entered into a contract with the department of medicaid pursuant to section 5167.10 of the Revised Code;
(7) Any other person or government entity that is, by law, contract, or agreement, responsible for paying for or processing a claim for payment for the provision of dangerous drugs or pharmacy services.
(F) "Pharmacy audit" means a review of one or more pharmacy records conducted by an auditing entity, one purpose of which is to identify discrepancies in claims for payment for the provision of dangerous drugs or pharmacy services. "Pharmacy audit" does not include concurrent review.
(G) "Pharmacy benefit manager" means a person that provides administrative services related to the processing of claims for payment for the provision of dangerous drugs or pharmacy services, including performing pharmacy audit compliance, negotiating pharmaceutical rebate agreements, developing and managing drug formularies and preferred drug lists, and administering programs for payers' prior authorization of claims for payment for the provision of dangerous drugs or pharmacy services.
(H) "Pharmacy record" means any record stored electronically or as a hard copy by a pharmacy that relates to the provision of dangerous drugs or pharmacy services or any other component of pharmacist care that is included in the practice of pharmacy.