Effective: October 16, 2009
Latest Legislation: House Bill 1 - 128th General Assembly
(A) A health insuring corporation shall establish and maintain a complaint system that has been approved by the superintendent of insurance to provide adequate and reasonable procedures for the expeditious resolution of written complaints initiated by subscribers or enrollees concerning any matter relating to services provided, directly or indirectly, by the health insuring corporation, including, but not limited to, complaints regarding cancellations or nonrenewals of coverage. Complaints regarding a health insuring corporation's decision to deny, reduce, or terminate coverage for health care services are subject to section 1751.83 of the Revised Code.
(B) A health insuring corporation shall provide a timely written response to each written complaint it receives.
(C)(1) Copies of complaints and responses, including medical records related to those complaints, shall be available to the superintendent for inspection for three years. Any document or information provided to the superintendent pursuant to this division that contains a medical record is confidential, and is not a public record subject to section 149.43 of the Revised Code.
(2) Notwithstanding division (C)(1) of this section, the superintendent may share documents and information that contain a medical record in connection with the investigation or prosecution of any illegal or criminal activity with the chief deputy rehabilitator, the chief deputy liquidator, other deputy rehabilitators and liquidators, and any other person employed by, or acting on behalf of, the superintendent pursuant to Chapter 3901. or 3903. of the Revised Code, with other local, state, federal, and international regulatory and law enforcement agencies, with local, state, and federal prosecutors, and with the national association of insurance commissioners and its affiliates and subsidiaries, provided that the recipient agrees to maintain the confidential or privileged status of the confidential or privileged document or information and has authority to do so.
(3) Nothing in this section shall prohibit the superintendent from receiving documents and information in accordance with section 3901.045 of the Revised Code.
(4) The superintendent may enter into agreements governing the sharing and use of documents and information consistent with the requirements of this section.
(5) No waiver of any applicable privilege or claim of confidentiality in the documents and information described in division (C)(1) of this section occurs as a result of sharing or receiving documents and information as authorized in divisions (C)(2) and (3) of this section.
(D) A health insuring corporation shall establish and maintain a procedure to accept complaints over the telephone or in person. These complaints are not subject to the reporting requirement under division (C) of section 1751.32 of the Revised Code.
(E) A health insuring corporation may comply with this section and section 1751.83 of the Revised Code by establishing one system for receiving and reviewing complaints and requests for internal review from enrollees and subscribers if the system meets the requirements of both sections.
Structure Ohio Revised Code
Title 17 | Corporations-Partnerships
Chapter 1751 | Health Insuring Corporation Law
Section 1751.01 | Health Insuring Corporation Law Definitions.
Section 1751.02 | Applying for Certificate of Authority.
Section 1751.03 | Verification of Application.
Section 1751.04 | Review of Application and Documents by Superintendent.
Section 1751.05 | Issuance or Denial of Certificate of Authority.
Section 1751.06 | Powers Upon Obtaining Certificate.
Section 1751.07 | Responsibility for Funds.
Section 1751.08 | Inapplicability of Insurance Laws.
Section 1751.11 | Evidence of Coverage.
Section 1751.12 | Contractual Periodic Prepayment or Premium Rate.
Section 1751.13 | Contracts With Providers and Health Care Facilities.
Section 1751.14 | Termination of Coverage of Child.
Section 1751.18 | Cancelling or Failing to Renew Coverage.
Section 1751.19 | Complaint System.
Section 1751.20 | Unfair, Untrue, Misleading, or Deceptive Acts.
Section 1751.21 | Peer Review Committee.
Section 1751.25 | Investment of Funds.
Section 1751.26 | Investments in Real Estate.
Section 1751.27 | Deposit of Securities With Superintendent or Custodian.
Section 1751.271 | Medicaid Providers - Performance Bond.
Section 1751.31 | Changes in Corporation's Solicitation Document.
Section 1751.32 | Annual Report.
Section 1751.321 | Audit Report Filed Annually.
Section 1751.33 | Information to Be Provided to Subscribers.
Section 1751.34 | Examinations by Superintendent and Director.
Section 1751.35 | Suspension or Revocation of Certificate of Authority.
Section 1751.38 | Applicability of Other Laws.
Section 1751.40 | Insurance Companies Operating as Health Insuring Corporations.
Section 1751.42 | Rehabilitation, Liquidation, Supervision or Conservation of Corporation.
Section 1751.44 | Fees Paid to Superintendent of Insurance.
Section 1751.45 | Administrative Penalties - Violations.
Section 1751.46 | Recommendations for Expansion of Service Areas.
Section 1751.47 | Adopting Forms, Instructions and Manuals for Providing Financial Information.
Section 1751.51 | Restrictions on Choice of Providers.
Section 1751.52 | Confidentiality of Information.
Section 1751.521 | Medical Information Release.
Section 1751.53 | Continuing Coverage After Termination of Employment.
Section 1751.54 | Continuing Coverage After Reservist Called to Duty.
Section 1751.55 | Effect of Workers Compensation Coverage.
Section 1751.56 | Effect of Supplemental Sickness and Accident Insurance Policy.
Section 1751.57 | Conditions Applying to All Individual Health Insuring Corporation Contracts.
Section 1751.59 | Coverage of Adopted Children.
Section 1751.61 | Coverage for Newly Born Child.
Section 1751.62 | Screening Mammography - Cytologic Screening for Cervical Cancer.
Section 1751.63 | Long-Term Care Insurance.
Section 1751.65 | Health Insuring Corporation - Prohibited Activities.
Section 1751.66 | Prescription Drugs.
Section 1751.67 | Maternity Benefits.
Section 1751.68 | Provisions for Medication Synchronization for Enrollees.
Section 1751.70 | Authorization of Payroll Deductions for Public Employees.
Section 1751.71 | Accepting Payments for Cost of Policies, Contracts, and Agreements.
Section 1751.72 | Policy, Contract, or Agreement Containing a Prior Authorization Requirement.
Section 1751.73 | Implementing Quality Assurance Programs.
Section 1751.74 | Quality Assurance Program Requirements.
Section 1751.75 | Determination That Accreditation Constitutes Compliance.
Section 1751.77 | Utilization Review, Internal and External Review Procedure Definitions.
Section 1751.78 | Application of Provisions.
Section 1751.79 | Utilization Review Program Requirements.
Section 1751.80 | Implementing Utilization Review Programs.
Section 1751.811 | Internal and External Reviews.
Section 1751.82 | Reconsideration of Adverse Determination.
Section 1751.821 | Determination That Accreditation Constitutes Compliance.
Section 1751.822 | Cooperation With Utilization Review Program.
Section 1751.823 | Filing Certificate of Compliance.
Section 1751.83 | Maintaining Internal Review System.
Section 1751.84 | Coverage for Autism Spectrum Disorder.
Section 1751.85 | Information for Vision Care Services or Materials.
Section 1751.86 | Violation Deemed Unfair and Deceptive Act or Practice.
Section 1751.87 | Cause of Action Not Created.
Section 1751.89 | Medicare and Medicaid Exceptions.
Section 1751.90 | Coverage for Teledentistry.
Section 1751.91 | Reimbursement for Pharmacists Providing Health Care.