reglab/statecodes huggingface dataset:
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.11 | Acquisition of Stock of Other Insurers.

Effective:
October 1, 1953
Latest Legislation:
House Bill 1 - 100th General Assembly
Any domestic insurer and any foreign or alien insurer authorized to do business in this state may retain, invest in, or acquire the whole or any part of the capital stock of any other insurer, or have a common management with any other insurer, provided such retention, investment, acquisition, or common management is not inconsistent with any other law relating to the investment of the funds of domestic insurers, and provided further that by reason of such retention, investment, or acquisition of such capital stock, or common management, the business of such insurers with the public shall not be conducted in a manner which substantially lessens competition generally in the business of insurance or creates a monopoly therein.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.12 | Interlocking Directorate.

Effective:
October 1, 1953
Latest Legislation:
House Bill 1 - 100th General Assembly
Any person otherwise qualified may be a director of two or more insurers which are competitors or which have a common management, but no such interlocking directorate shall be used as a means of substantially lessening competition generally in the business of insurance or of creating a monopoly therein.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.13 | Hearing by Superintendent.

Effective:
October 1, 1953
Latest Legislation:
House Bill 1 - 100th General Assembly
Whenever the superintendent of insurance has reason to believe that there is a violation of section 3901.11 or 3901.12 of the Revised Code, he shall serve upon the insurers and directors a notice of a hearing before the superintendent to be held not less than thirty days after the service of such notice, and requiring such insurers and directors to show cause why an order should not be made by the superintendent directing such insurers and directors to cease and desist from such violation. All such hearings shall be conducted in accordance with sections 119.01 to 119.13, inclusive, of the Revised Code.
If, upon such hearing, the superintendent finds that there has been a violation of section 3901.11 or 3901.12 of the Revised Code, he shall issue and cause to be served upon such insurers and directors an order reciting the facts found by him, setting forth the respects in which there has been a violation, and directing such insurers and directors to cease and desist from such violation.
Any such order of the superintendent shall be subject to judicial review in accordance with sections 119.01 to 119.13, inclusive, of the Revised Code. A violation of any such order is, subject to said judicial review, deemed a violation as contemplated by section 3901.16 or 3901.17 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.14 | Record and Report of Superintendent.

Effective:
September 6, 1965
Latest Legislation:
House Bill 149 - 106th General Assembly
The superintendent of insurance shall preserve a full record of his proceedings, including a concise statement of the condition of each insurance company or association authorized to transact business in this state. Each year the superintendent shall report their general conduct and condition, including the information contained in the statement required of them, arranged in tabular form in two separate reports, one pertaining to life insurance companies and the second to all other insurance companies.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.16 | Forfeiture.

Effective:
October 1, 1998
Latest Legislation:
House Bill 361 - 122nd General Assembly
Any association, company, or corporation, including a health insuring corporation, which violates any law relating to the superintendent of insurance, any provision of Chapter 1751. or 1753. of the Revised Code, or any insurance law of this state, for the violation of which no forfeiture or penalty is elsewhere provided in the Revised Code, shall forfeit and pay not less than one thousand nor more than ten thousand dollars, to be recovered by an action in the name of the state and on collection to be paid to the superintendent, who shall pay such sum into the state treasury.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.18 | Requirements for Unauthorized Foreign or Alien Insurer to Enter an Appearance.

Effective:
November 21, 1967
Latest Legislation:
House Bill 436 - 107th General Assembly
(A) Before any unauthorized foreign or alien insurer may enter an appearance in any court action, suit, or proceeding or in any administrative proceeding before the superintendent of insurance, such unauthorized insurer shall either:
(1) Deposit with the clerk of the court in which such action, suit, or proceeding is pending or with the superintendent if such proceeding is before him, cash or securities or file with such clerk or the superintendent a bond with good and sufficient sureties, to be approved by the court or the superintendent, in an amount to be fixed by the court sufficient to secure the payment of any final judgment which may be rendered in any such court action, suit, or proceeding or by the superintendent sufficient to satisfy any order issued by the superintendent;
(2) Procure a certificate of authority to transact the business of insurance in this state.
(B) In any action, suit, or proceeding, in which service is made in the manner provided in division (B) or (C) of section 3901.17 of the Revised Code the court or, if the proceeding is before the superintendent of insurance, the superintendent may order such postponement as may be necessary to afford the unauthorized insurer reasonable opportunity to comply with the provisions of division (A) of this section and to defend such action, suit, or proceeding.
(C) Nothing in division (A) of this section shall prevent an unauthorized foreign or alien insurer from filing a motion to set aside service made in the manner provided in division (B) or (C) of section 3901.17 of the Revised Code on the ground either:
(1) That such unauthorized insurer has not done any of the acts enumerated in division (A) of section 3901.17 of the Revised Code;
(2) That the person on whom service was made pursuant to division (C) of section 3901.17 of the Revised Code was not doing or had not done any of the acts enumerated in division (C) of section 3901.17 of the Revised Code.
(D) The provisions of this section do not apply to ocean marine insurance.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.19 | Unfair and Deceptive Practices Definitions.

Effective:
September 1, 2002
Latest Legislation:
Senate Bill 129 - 124th General Assembly
As used in sections 3901.19 to 3901.26 of the Revised Code:
(A) "Person" means any individual, corporation, association, partnership, reciprocal exchange, inter-insurer, fraternal benefit society, title guarantee and trust company, health insuring corporation, and any other legal entity.
(B) "Residents" includes any individual, partnership, or corporation.
(C) "Maternity benefits" means those benefits calculated to indemnify the insured for hospital and medical expenses fairly and reasonably associated with a pregnancy and childbirth.
(D) "Insurance" includes, but is not limited to, any policy or contract offered, issued, sold, or marketed by an insurer, corporation, association, organization, or entity regulated by the superintendent of insurance or doing business in this state. Nothing in any other section of the Revised Code shall be construed to exclude single premium deferred annuities from the regulation of the superintendent under sections 3901.19 to 3901.26 of the Revised Code.
(E) "Affiliate" means any company that controls, is controlled by, or is under common control with, another company.
(F) "Customer" means an individual who purchases, applies to purchase, or is solicited to purchase insurance products primarily for personal, family, or household purposes.
(G) "Depository institution" means a bank, savings bank, savings and loan association, or credit union that is subject to regulation or supervision by the United States or any state. "Depository institution" does not include an insurance company.
(H) "Insurance agent" or "agent" has the same meaning as in section 3905.01 of the Revised Code.
(I) "Insurer" has the same meaning as in section 3901.32 of the Revised Code.
(J) "Policy" or "certificate" means a contract of insurance, indemnity, medical, health or hospital service, suretyship, or annuity issued, proposed for issuance, or intended for issuance by any insurer.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.20 | Prohibition Against Unfair or Deceptive Acts.

Effective:
January 5, 1988
Latest Legislation:
House Bill 1 - 117th General Assembly
No person shall engage in this state in any trade practice which is defined in sections 3901.19 to 3901.23 of the Revised Code as, or determined pursuant to those sections to be, an unfair or deceptive act or practice in the business of insurance.
This section applies to any person, as defined in section 3901.19 of the Revised Code, regardless of whether the person is licensed or required to be licensed by the superintendent of insurance.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.212 | Consumer Protection Rules.

Effective:
July 21, 2022
Latest Legislation:
Senate Bill 256 - 134th General Assembly
(A) As used in sections 3901.212 to 3901.213 of the Revised Code, "consumer" means a policyholder, potential policyholder, certificate holder, potential certificate holder, insured, potential insured, or applicant.
(B) The superintendent may adopt rules pursuant to Chapter 119. of the Revised Code to implement the practices set forth in section 3901.213 of the Revised Code to ensure consumer protection. Such regulations, consistent with applicable law, may address all of the following:
(1) Consumer data protections and privacy;
(2) Consumer disclosure;
(3) Unfair discrimination;
(4) Any other matter the superintendent considers pertinent.
Last updated June 8, 2022 at 1:06 PM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.214 | Applicability of Prohibition on Inducements.

Effective:
July 21, 2022
Latest Legislation:
Senate Bill 256 - 134th General Assembly
The provisions of sections 3901.213 and 3933.01 of the Revised Code that prohibit a producer or insurer from giving rebates, discounts, gifts, or other valuable consideration as an inducement to insurance do not apply to commercial property and casualty insurance, but do apply to producer commission reductions not included in insurance company rate filings.
Last updated June 8, 2022 at 1:07 PM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.215 | Intent to Promote Innovation and Maintain Strong Consumer Protection.

Effective:
July 21, 2022
Latest Legislation:
Senate Bill 256 - 134th General Assembly
The intent of the general assembly in amending section 3901.21 of the Revised Code and enacting sections 3901.212 and 3901.213 of the Revised Code is to promote innovation in connection with the offering of value-added services while maintaining strong consumer protections.
Last updated June 8, 2022 at 1:07 PM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.221 | Cease-and-Desist Orders.

Effective:
January 5, 1988
Latest Legislation:
House Bill 1 - 117th General Assembly
If a violation of section 3901.20 of the Revised Code has caused, is causing, or is about to cause substantial and material harm, the superintendent of insurance may issue an order that the person cease and desist from any activity violating such section. Notice of the order shall be mailed by certified mail, return receipt requested, or served in any manner provided in section 3901.04 of the Revised Code, immediately after its issuance by the superintendent to the person subject to the order and to all persons known to be involved in the violation. The superintendent may thereafter publicize or otherwise make known to all interested persons that the order has been issued.
The notice shall specify the particular act, omission, practice, or transaction that is subject to the cease and desist order and shall set a date, not more than fifteen days after the date of the cease-and-desist order, for a hearing on the continuation or revocation of the order. The person shall comply with the order immediately upon receipt of notice of the order. The superintendent may, upon the application of a party and for good cause shown, continue the hearing. Chapter 119. of the Revised Code applies to such hearings to the extent that that chapter does not conflict with the procedures set forth in this section. The superintendent shall, within fifteen days after objections are submitted to the hearing officer's report and recommendation, issue a final order either confirming or revoking the cease-and-desist order. The final order may be appealed as provided under section 119.12 of the Revised Code. The remedy under this section is cumulative and concurrent with the remedies available under section 3901.22 of the Revised Code and may be enforced by the attorney general at the request of the superintendent as provided in division (E) of that section.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.23 | Self-Incrimination.

Effective:
January 9, 1961
Latest Legislation:
House Bill 1 - 104th General Assembly
If any person asks to be excused from attending and testifying or from producing any books, papers, records, correspondence, or other documents at any hearing on the ground that the testimony or evidence required of him may tend to incriminate him or subject him to a penalty or forfeiture and notwithstanding is directed to give such testimony or produce such evidence, he must none the less comply with such direction, but he shall not thereafter be prosecuted or subjected to any penalty or forfeiture for or on account of any transaction, matter, or thing concerning which he may testify or produce evidence pursuant thereto. No testimony so given or evidence produced shall be received against him upon any criminal action, investigation, or proceeding, provided that no such individual so testifying shall be exempt from prosecution or punishment for any perjury committed by him while so testifying. The testimony or evidence so given or produced shall be admissible against him upon any criminal action, investigation, or proceeding concerning such perjury. No such individual so testifying shall be exempt from the refusal, revocation, or suspension of any license, permission, or authority conferred, or to be conferred, pursuant to the insurance law of this state. Any such individual may execute, acknowledge, and file in the office of the superintendent of insurance a statement expressly waiving such immunity or privilege in respect to any transaction, matter, or thing specified in such statement; and thereupon the testimony of such person or such evidence in relation to such transaction, matter, or thing may be received or produced before any judge or justice, court, tribunal, grand jury, or otherwise, and if so received or produced, such individual shall not be entitled to any immunity or privilege on account of any testimony he may so give or evidence so produced.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.24 | Unlawful Advertising.

Effective:
February 21, 1967
Latest Legislation:
House Bill 1 - 107th General Assembly
No unauthorized foreign or alien insurer shall make, issue, circulate, or cause to be made, issued, or circulated, to residents of this state any estimate, illustration, circular, pamphlet, or letter, or cause to be made in any newspaper, magazine, or other publication or over any radio or television station, any announcement or statement to such residents misrepresenting its financial condition or the terms of any contracts issued or to be issued or the benefits or advantages promised thereby, or the dividends or share of the surplus to be received thereon in violation of sections 3901.19 to 3901.26, inclusive, of the Revised Code, and whenever the superintendent of insurance has reason to believe that any such insurer is engaging in such unlawful advertising, he shall give notice of such fact by registered mail to such insurer and to the insurance supervisory official of the domiciliary state of such insurer. For the purpose of this section, the domiciliary state of an alien insurer shall be deemed to be the state of entry or the state of the principal office in the United States.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.241 | List of Top Twenty per Cent of Services and Expected Contributions.

Effective:
September 29, 2015
Latest Legislation:
House Bill 64 - 131st General Assembly
(A) As used in this section:
(1) "Exchange" has the same meaning as in section 3905.01 of the Revised Code.
(2) "Enrollee's expected contribution" means any portion of the cost of a health service covered by a health benefit plan offered through an exchange that a person enrolled under such a plan would be expected to pay, including any copayments or cost sharing.
(B)(1) An insurer offering a health benefit plan through an exchange shall make available to individuals seeking information on the plan a list of the top twenty per cent of services, according to utilization of health services by individuals insured by the insurer, and an enrollee's expected contribution for each service.
(2) The enrollee's expected contribution for each service shall be provided both for situations in which the enrollee has and has not met any associated deductibles.
(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.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.25 | Action by Superintendent Against Insurer.

Effective:
February 21, 1967
Latest Legislation:
House Bill 1 - 107th General Assembly
If after thirty days following the giving of the notice mentioned in section 3901.24 of the Revised Code such insurer has failed to cease making, issuing, or circulating such false misrepresentations or causing the same to be made, issued, or circulated in this state, and if the superintendent of insurance has reason to believe that a proceeding by him in respect to such matters would be to the interest of the public, and that such insurer is issuing or delivering contracts of insurance to residents of this state or collecting premiums on such contracts or doing any of the acts enumerated in section 3901.26 of the Revised Code, he shall take action against such insurer under sections 3901.19 to 3901.26, inclusive, of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.27 | Adoption of Emergency Bylaws.

Effective:
November 11, 1965
Latest Legislation:
House Bill 561 - 106th General Assembly
The board of directors of any domestic insurance company may at any time adopt emergency bylaws, subject to repeal or change by action of those having power to adopt regular bylaws for the company, which shall be operative during an emergency, and which may, notwithstanding any different provisions of the regular bylaws, or of the applicable statutes, or of the company's charter, make any provision reasonably necessary for the operation of the company during the period of such emergency. An emergency shall exist when the president of the United States or the congress of the United States proclaims a national emergency because of an attack on the United States by nuclear or atomic weapons, or similar disaster, or when the governor of this state proclaims an emergency for corporations as described in division (U) of section 1701.01 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.28 | Provisions Effective if No Emergency Bylaws.

Effective:
November 11, 1965
Latest Legislation:
House Bill 561 - 106th General Assembly
In the event that the board of directors of a domestic insurance company has not adopted emergency bylaws, the following provisions shall become effective upon the occurrence of an emergency as described in section 3901.27 of the Revised Code.
(A) Three directors shall constitute a quorum for the transaction of business at all meetings of the board.
(B) Any vacancy in the board may be filled by a majority of the remaining directors, though less than a quorum, or by a sole remaining director.
(C) If there are no surviving directors, but at least three vice-presidents of the company survive, the three vice-presidents with the longest term of service shall be the directors and shall possess all of the powers of the previous board of directors and such powers as are granted herein or by subsequently enacted legislation. By majority vote, said emergency board of directors may elect other directors. If there are not at least three surviving vice-presidents, the superintendent of insurance or duly designated person exercising the powers of the superintendent shall appoint three persons as directors who shall possess all of the powers of the previous board of directors and such powers as are granted herein or by subsequently enacted legislation, and these directors may, by majority vote, elect other directors.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.29 | Succession List.

Effective:
November 11, 1965
Latest Legislation:
House Bill 561 - 106th General Assembly
At any time the board of directors of a domestic insurance company may, by resolution, provide that in the event of an emergency, as described in section 3901.27 of the Revised Code, and in the event of the death or incapacity of the president, the secretary, or the treasurer of the company, such officers or any of them shall be succeeded in the office by the person named or described in a succession list adopted by the board of directors. Such list may be on the basis of named persons or position titles, and shall establish the order of priority and prescribe the conditions under which the powers of the office shall be exercised.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.30 | Emergency Business Location.

Effective:
November 11, 1965
Latest Legislation:
House Bill 561 - 106th General Assembly
At any time, the board of directors of a domestic insurance company may, by resolution, provide that in the event of an emergency, as described in section 3901.27 of the Revised Code, the home office or principal place of business of the company shall be at such location as is named or described in the resolution. Such resolution may provide for alternate locations and establish an order of preference.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.323 | Jurisdiction.

Effective:
March 17, 1989
Latest Legislation:
House Bill 875 - 117th General Assembly
(A) The courts of this state have personal jurisdiction over both of the following:
(1) Every person that is not a resident or domiciliary of, nor authorized to do business in, this state, and that files a statement with the superintendent of insurance under section 3901.321 of the Revised Code;
(2) All actions involving such person arising out of violations of section 3901.321 of the Revised Code.
(B) Each person described in division (A) of this section is deemed to have performed acts equivalent to and constituting an appointment of the superintendent to be his attorney upon whom may be served all process in any action, suit, or proceeding arising out of violations of section 3901.321 of the Revised Code. Copies of all such process shall be served on the superintendent and transmitted by certified mail by the superintendent to such person at his last known address.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.351 | Participation in Supervisory College.

Effective:
September 4, 2014
Latest Legislation:
Senate Bill 140 - 130th General Assembly
(A) With respect to any insurer registered under section 3901.33 of the Revised Code and in accordance with division (C) of this section, the superintendent of insurance may participate in a supervisory college for any domestic insurer that is part of an insurance holding company system with international operations in order to determine compliance by the insurer with sections 3901.32 to 3901.37 of the Revised Code. In participating, the superintendent may do all of the following:
(1) Initiate the establishment of a supervisory college;
(2) Clarify the membership and participation of other supervisors in the supervisory college;
(3) Clarify the functions of the supervisory college and the role of other regulators, including the establishment of a group-wide supervisor;
(4) Coordinate the ongoing activities of the supervisory college, including planning meetings, supervisory activities, and processes for information sharing;
(5) Establish a crisis management plan.
(B) Each registered insurer subject to this section shall be liable for and shall pay the reasonable expenses of the superintendent's participation in a supervisory college in accordance with division (C) of this section, including reasonable travel expenses. The superintendent may establish a regular assessment to the insurer for the payment of these expenses. A supervisory college may be convened as either a temporary or permanent forum for communication and cooperation between the regulators charged with the supervision of the insurer or its affiliates.
(C) In order to assess the business strategy, financial position, legal and regulatory position, risk exposure, risk management, and governance processes, and as part of the examination of individual insurers in accordance with section 3901.35 of the Revised Code, the superintendent may participate in a supervisory college with other regulators charged with supervision of the insurer or its affiliates, including other state, federal, and international regulatory agencies. The superintendent may enter into agreements in accordance with section 3901.36 of the Revised Code that provide the basis for cooperation between the superintendent and the other regulatory agencies, and the activities of the supervisory college.
(D) Nothing in this section shall delegate to the supervisory college the authority of the superintendent to regulate or supervise the insurer or its affiliates within its jurisdiction.
(E) As used in this section, "supervisory college" means a forum for cooperation and communication between the involved supervisors established for the fundamental purpose of facilitating all of the following:
(1) The effectiveness of supervision of entities that belong to an insurance group;
(2) The supervision of the insurance group as a whole on a group-wide basis;
(3) Improving the legal entity supervision of the entities within the insurance group.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.37 | Suspension, Revocation or Refusal to Renew License - Civil Forfeiture.

Effective:
October 1, 1993
Latest Legislation:
Senate Bill 136 - 120th General Assembly
(A) Whenever it appears to the superintendent of insurance that any person has committed a violation of section 3901.33, 3901.34, 3901.341, or 3901.35 of the Revised Code, which makes the continued operation of an insurer contrary to the interests of policyholders or the public, the superintendent may, subject to Chapter 119. of the Revised Code, suspend, revoke, or refuse to renew such insurer's license or authority to do business in this state for such period as he finds is required for the protection of policyholders or the public.
(B) Whenever an extraordinary dividend is paid in knowing violation of division (C) of section 3901.34 of the Revised Code, the superintendent may, subject to Chapter 119. of the Revised Code, cause the insurer to pay a civil forfeiture of not more than two hundred fifty thousand dollars, to be paid to the state treasury to the credit of the department of insurance operating fund. Each payment of an extraordinary dividend made in violation of division (C) of section 3901.34 of the Revised Code may be considered a separate offense.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.371 | Purpose of Sections 3901.371 to 3901.378.

Effective:
January 1, 2015
Latest Legislation:
Senate Bill 140 - 130th General Assembly
The purpose of sections 3901.371 to 3901.378 of the Revised Code is to provide the requirements for maintaining a risk management framework and completing an own risk and solvency assessment, and to provide guidance and instructions for filing an own risk and solvency assessment summary report with the superintendent of insurance. The requirements of these sections shall apply to all insurers domiciled in this state unless exempt pursuant to section 3901.376 of the Revised Code.
The general assembly finds and declares that the own risk and solvency assessment summary report will contain confidential and sensitive information related to an insurer or insurance group's identification of risks material and relevant to the insurer or insurance group filing the report. This information will include proprietary and trade secret information that has the potential for harm and competitive disadvantage to the insurer or insurance group if the information is made public. It is the intent of the general assembly that the own risk and solvency assessment summary report shall be a confidential document filed with the superintendent, that the own risk and solvency assessment summary report will be shared only as stated in sections 3901.371 to 3901.378 of the Revised Code to assist the superintendent of insurance in the performance of the superintendent's duties, and that in no event shall the own risk and solvency assessment summary report be subject to public disclosure.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.372 | Definitions.

Effective:
January 1, 2015
Latest Legislation:
Senate Bill 140 - 130th General Assembly
For the purposes of sections 3901.371 to 3907.378 of the Revised Code:
(A) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in section 3901.32 of the Revised Code.
(B) "Insurer" has the same meaning as set forth in section 3901.32 of the Revised Code.
(C) "Own risk and solvency assessment" means a confidential internal assessment, appropriate to the nature, scale, and complexity of an insurer or insurance group, conducted by that insurer or insurance group of the material and relevant risks associated with the insurer or insurance group's current business plan, and the sufficiency of capital resources to support those risks.
(D) "Own risk and solvency assessment guidance manual" means the current version of the own risk and solvency assessment guidance manual developed and adopted by the national association of insurance commissioners and as amended from time to time. A change in the own risk and solvency assessment guidance manual shall be effective on the first day of January following the calendar year in which the changes have been adopted by the national association of insurance commissioners.
(E) "Own risk and solvency assessment summary report" means a confidential high-level summary of an insurer or insurance group's own risk and solvency assessment.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.373 | Risk Management Framework.

Effective:
January 1, 2015
Latest Legislation:
Senate Bill 140 - 130th General Assembly
An insurer shall maintain a risk management framework to assist the insurer with identifying, assessing, monitoring, managing, and reporting on its material and relevant risks. This requirement may be satisfied if the insurance group of which the insurer is a member maintains a risk management framework applicable to the operations of the insurer.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.374 | Own Risk and Solvency Assessment.

Effective:
January 1, 2015
Latest Legislation:
Senate Bill 140 - 130th General Assembly
Unless exempted by section 3901.376 of the Revised Code, an insurer, or the insurance group of which the insurer is a member, shall regularly conduct an own risk and solvency assessment consistent with a process comparable to the own risk and solvency assessment guidance manual. The own risk and solvency assessment shall be conducted not less than annually, but also at any time when there are significant changes to the risk profile of the insurer or the insurance group of which the insurer is a member.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.375 | Summary Report.

Effective:
January 1, 2015
Latest Legislation:
Senate Bill 140 - 130th General Assembly
(A)(1) Upon the request of the superintendent of insurance, and not more than once annually, an insurer shall submit to the superintendent an own risk and solvency assessment summary report, or any combination of reports that together contain the information described in the own risk and solvency assessment guidance manual, applicable to the insurer or the insurance group of which it is a member.
(2) Notwithstanding any request from the superintendent, if the insurer is a member of an insurance group, the insurer shall submit the report required by division (A)(1) of this section if the superintendent is the lead state commissioner of the insurance group as determined by the procedures within the financial analysis handbook adopted by the national association of insurance commissioners.
(B) The report shall include a signature of the insurer or insurance group's chief risk officer, or other executive having responsibility for the oversight of the insurer's enterprise risk management process, attesting to the best of the officer's or executive's belief and knowledge that the insurer applies the enterprise risk management process described in the own risk and solvency assessment summary report, and that a copy of the report has been provided to the insurer's board of directors or the appropriate committee thereof.
(C) An insurer may comply with division (A) of this section by providing the most recent and substantially similar report provided by the insurer or another member of an insurance group of which the insurer is a member to the commissioner of another state or to a supervisor or regulator of a foreign jurisdiction, if that report provides information that is comparable to the information described in the own risk and solvency assessment guidance manual. Any such report in a language other than English must be accompanied by a translation of that report into the English language.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.377 | Form and Content of Report; Review.

Effective:
January 1, 2015
Latest Legislation:
Senate Bill 140 - 130th General Assembly
(A) The own risk and solvency assessment summary report shall be prepared consistent with the own risk and solvency assessment guidance manual, subject to the requirements of division (B) of this section, and all documentation and supporting information shall be maintained and made available for examination upon request of the superintendent of insurance.
(B) The superintendent's review of the own risk and solvency assessment summary report, and any additional requests for information, shall be made using similar procedures used in the analysis and examination of multi-state or global insurers and insurance groups.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.38 | Prompt Payments to Health Care Providers Definitions.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
As used in this section and sections 3901.381 to 3901.3814 of the Revised Code:
(A) "Beneficiary" means any policyholder, subscriber, member, employee, or other person who is eligible for benefits under a benefits contract.
(B) "Benefits contract" means a sickness and accident insurance policy providing hospital, surgical, or medical expense coverage, or a health insuring corporation contract or other policy or agreement under which a third-party payer agrees to reimburse for covered health care or dental services rendered to beneficiaries, up to the limits and exclusions contained in the benefits contract.
(C) "Hospital" has the same meaning as in section 3727.01 of the Revised Code.
(D) "Provider" means a hospital, nursing home, physician, podiatrist, dentist, pharmacist, chiropractor, or other health care provider entitled to reimbursement by a third-party payer for services rendered to a beneficiary under a benefits contract.
(E) "Reimburse" means indemnify, make payment, or otherwise accept responsibility for payment for health care services rendered to a beneficiary, or arrange for the provision of health care services to a beneficiary.
(F) "Third-party payer" means any of the following:
(1) An insurance company;
(2) A health insuring corporation;
(3) A labor organization;
(4) An employer;
(5) An intermediary organization, as defined in section 1751.01 of the Revised Code, that is not a health delivery network contracting solely with self-insured employers;
(6) An administrator subject to sections 3959.01 to 3959.16 of the Revised Code;
(7) A health delivery network, as defined in section 1751.01 of the Revised Code;
(8) Any other person that is obligated pursuant to a benefits contract to reimburse for covered health care services rendered to beneficiaries under such contract.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.382 | Electronic Submission of Claims.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
Beginning six months after the date specified in section 262 of the "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 2027, 42 U.S.C.A. 1320d-4, on which a third-party payer is initially required to comply with a standard or implementation specification for the electronic exchange of health information, as adopted or established by the United States secretary of health and human services pursuant to that act, sections 3901.381, 3901.384, 3901.385, 3901.389, 3901.3810, 3901.3811, 3901.3812, and 3901.3813 of the Revised Code apply to a claim submitted to a third-party payer for payment for health care services only if the claim is submitted electronically. A provider and third-party payer may enter into a contractual arrangement under which the third-party payer agrees to process claims that are not submitted electronically because of the financial hardship that electronic submission of claims would create for the provider or any other extenuating circumstance.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.383 | Contractual Agreements for Payments by Third-Party Payers.

Effective:
June 30, 2006
Latest Legislation:
House Bill 530 - 126th General Assembly
(A) A provider and a third-party payer may do either of the following:
(1) Enter into a contractual agreement under which time periods shorter than those set forth in section 3901.381 of the Revised Code are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider;
(2) Enter into a contractual agreement under which the timing of payments by the third-party payer is not directly related to the receipt of a claim form. The contractual arrangement may include periodic interim payment arrangements, capitation payment arrangements, or other periodic payment arrangements acceptable to the provider and the third-party payer. Under a capitation payment arrangement, the third-party payer shall begin paying the capitated amounts to the beneficiary's primary care provider not later than sixty days after the date the beneficiary selects or is assigned to the provider. Under any other contractual periodic payment arrangement, the contractual agreement shall state, with specificity, the timing of payments by the third-party payer.
(B) Regardless of whether a third-party payer is exempted under division (D) of section 3901.3814 from sections 3901.38 and 3901.381 to 3901.3813 of the Revised Code, a provider and the third-party payer, including a third-party payer that provides coverage under the medicaid program, shall not enter into a contractual arrangement under which time periods longer than those provided for in paragraph (c)(1) of 42 C.F.R. 447.46 are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.384 | Untimely Claim Process.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
(A) Subject to division (B) of this section, a third-party payer that requires timely submission of claims for payment for health care services shall process a claim that is not submitted in a timely manner if a claim for the same services was initially submitted to a different third-party payer or state or federal program that offers health care benefits and that payer or program has determined that it is not responsible for the cost of the health care services. When a claim is submitted later than one year after the last date of service for which reimbursement is sought under the claim, the third-party payer shall pay or deny the claim not later than ninety days after receipt of the claim or, alternatively, pursuant to the requirements of sections 3901.381 to 3901.388 of the Revised Code. The third-party payer must make an election to process such claims either within the ninety-day period or under section 3901.381 of the Revised Code. If the claim is denied, the third-party payer shall notify the provider and the beneficiary. The notice shall state, with specificity, why the third-party payer denied the claim.
(B) The third-party payer may refuse to process a claim submitted by a provider if the provider submits the claim later than forty-five days after receiving notice from the different third-party payer or a state or federal program that that payer or program is not responsible for the cost of the health care services, or if the provider does not submit the notice of denial from the different third-party payer or program with the claim. The failure of a provider to submit a notice of denial in accordance with this division shall not affect the terms of a benefits contract.
(C) For purposes of this section, both of the following apply:
(1) A determination that a third-party payer or state or federal program is not responsible for the cost of health care services includes a determination regarding coordination of benefits, preexisting health conditions, ineligibility for coverage at the time services were provided, subrogation provisions, and similar findings;
(2) State and federal programs that offer health care benefits include medicare, medicaid, workers' compensation, the civilian health and medical program of the uniformed services and other elements of the tricare program offered by the United States department of defense, and similar state or federal programs.
(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 3901.385 | Third-Party Payer - Prohibited Acts.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
A third-party payer shall not do either of the following:
(A) Engage in any business practice that unfairly or unnecessarily delays the processing of a claim or the payment of any amount due for health care services rendered by a provider to a beneficiary;
(B) Refuse to process or pay within the time periods specified in section 3901.381 of the Revised Code a claim submitted by a provider on the grounds the beneficiary has not been discharged from the hospital or the treatment has not been completed, if the submitted claim covers services actually rendered and charges actually incurred over at least a thirty-day period.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.386 | Reimbursement Contract - Reimbursements to Be Made Directly to Hospital - Assignment of Benefits.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
(A) Notwithstanding section 1751.13 or division (I)(2) of section 3923.04 of the Revised Code, a reimbursement contract entered into or renewed on or after June 29, 1988, between a third-party payer and a hospital shall provide that reimbursement for any service provided by a hospital pursuant to a reimbursement contract and covered under a benefits contract shall be made directly to the hospital.
(B) If the third-party payer and the hospital have not entered into a contract regarding the provision and reimbursement of covered services, the third-party payer shall accept and honor a completed and validly executed assignment of benefits with a hospital by a beneficiary, except when the third-party payer has notified the hospital in writing of the conditions under which the third-party payer will not accept and honor an assignment of benefits. Such notice shall be made annually.
(C) A third-party payer may not refuse to accept and honor a validly executed assignment of benefits with a hospital pursuant to division (B) of this section for medically necessary hospital services provided on an emergency basis.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3901 | Superintendent of Insurance › Section 3901.387 | Duplicative Claims - Claim Information System.

Effective:
July 24, 2002
Latest Legislation:
Senate Bill 4 - 124th General Assembly
(A) When a provider or beneficiary submits a duplicative claim for payment for health care services before the time periods specified in section 3901.381 of the Revised Code have elapsed for the original claim submitted, the third-party payer may deny the duplicative claim. Denials of claims determined to be duplicative by the department of insurance shall not be considered by the department in a market conduct examination of a third-party payer's compliance with section 3901.381 of the Revised Code. The superintendent of insurance shall have the discretion to exclude an original claim in determining a violation under section 3901.381 of the Revised Code.
(B)(1) A third-party payer shall establish a system whereby a provider and a beneficiary may obtain information regarding the status of a claim for payment for health care services, provided the claim is not materially deficient. A third-party payer shall inform providers and beneficiaries of the mechanisms that may be used to gain access to the system.
(2) If a third-party payer delegates the processing of payments to another entity, the third-party payer shall require the entity to comply with division (B)(1) of this section on behalf of the third-party payer.