Effective: September 30, 2021
Latest Legislation: House Bill 110 - 134th General Assembly
As used in sections 3902.50 to 3902.72 of the Revised Code:
(A) "Ambulance" has the same meaning as in section 4765.01 of the Revised Code.
(B) "Clinical laboratory services" has the same meaning as in section 4731.65 of the Revised Code.
(C) "Cost sharing" means the cost to a covered person under a health benefit plan according to any copayment, coinsurance, deductible, or other out-of-pocket expense requirement.
(D) "Covered" or "coverage" means the provision of benefits related to health care services to a covered person in accordance with a health benefit plan.
(E) "Covered person," "health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code.
(F) "Drug" has the same meaning as in section 4729.01 of the Revised Code.
(G) "Emergency facility" has the same meaning as in section 3701.74 of the Revised Code.
(H) "Emergency services" means all of the following as described in 42 U.S.C. 1395dd:
(1) Medical screening examinations undertaken to determine whether an emergency medical condition exists;
(2) Treatment necessary to stabilize an emergency medical condition;
(3) Appropriate transfers undertaken prior to an emergency medical condition being stabilized.
(I) "Health care practitioner" has the same meaning as in section 3701.74 of the Revised Code.
(J) "Pharmacy benefit manager" has the same meaning as in section 3959.01 of the Revised Code.
(K) "Prior authorization requirement" means any practice implemented by a health plan issuer in which coverage of a health care service, device, or drug is dependent upon a covered person or a provider obtaining approval from the health plan issuer prior to the service, device, or drug being performed, received, or prescribed, as applicable. "Prior authorization requirement" includes prospective or utilization review procedures conducted prior to providing a health care service, device, or drug.
(L) "Unanticipated out-of-network care" means health care services, including clinical laboratory services, that are covered under a health benefit plan and that are provided by an out-of-network provider when either of the following conditions applies:
(1) The covered person did not have the ability to request such services from an in-network provider.
(2) The services provided were emergency services.
Last updated September 9, 2021 at 5:16 PM
Structure Ohio Revised Code
Chapter 3902 | Insurance Policies and Contracts
Section 3902.01 | Purpose of Sections.
Section 3902.02 | Insurance Policy and Contract Definitions.
Section 3902.03 | Policies to Which Sections Apply - Exceptions - Non-English Language Policies.
Section 3902.04 | Requirements for Policy Forms.
Section 3902.05 | Construction.
Section 3902.06 | Superintendent May Authorize Lower Test Score.
Section 3902.07 | Approval of Policy Form Notwithstanding Provisions of Other Laws.
Section 3902.08 | Policy Forms Compliance Date.
Section 3902.11 | Coordination of Benefits Definitions.
Section 3902.12 | Primary or Secondary Health Coverage.
Section 3902.13 | Order of Benefits for Health Coverage Plan.
Section 3902.21 | Standard Claim Form Definitions.
Section 3902.22 | Superintendent to Develop Standard Claim Form.
Section 3902.23 | Use of Form Mandatory.
Section 3902.30 | Coverage for Telehealth Services.
Section 3902.31 | Void Contracts.
Section 3902.36 | Compliance With Federal Mental Health and Addiction Parity Laws.
Section 3902.50 | Definitions for r.c. 3902.50 to 3902.72.
Section 3902.51 | Out-of-Network Care Reimbursement Requirement, Negotiations.
Section 3902.52 | Out-of-Network Care Arbitration.
Section 3902.53 | Out-of-Network Care Rules, Prompt Pay Requirements, Violations.
Section 3902.54 | Out-of-Network Care Arbitrator Requirements.
Section 3902.60 | Advanced Cancer Fail First Drug Coverage Definitions.
Section 3902.61 | Advanced Cancer Fail First Drug Coverage Prohibitions.
Section 3902.62 | Coverage for Drugs Refilled Without a Prescription.
Section 3902.70 | Health Plan Issuer Contracts With 340b Program Participants Definitions.
Section 3902.71 | Health Plan Issuer Contracts With 340b Program Participants.
Section 3902.72 | Health Plan Issuer Disclosure of Drug Data.