Effective: March 22, 2005
Latest Legislation: House Bill 331 - 125th General Assembly
(A) As used in this section, "screening mammography" means a radiologic examination utilized to detect unsuspected breast cancer at an early stage in asymptomatic women and includes the x-ray examination of the breast using equipment that is dedicated specifically for mammography including, but not limited to, the x-ray tube, filter, compression device, screens, film, and cassettes, and that has an average radiation exposure delivery of less than one rad mid-breast. "Screening mammography" includes two views for each breast. The term also includes the professional interpretation of the film.
"Screening mammography" does not include diagnostic mammography.
(B) Each employer in this state that provides, in whole or in part, health care benefits for its employees under a policy of sickness and accident insurance issued in accordance with Chapter 3923. of the Revised Code shall also provide to its employees benefits for the expenses of both of the following:
(1) Screening mammography to detect the presence of breast cancer in adult women;
(2) Cytologic screening for the presence of cervical cancer.
(C) An employer may comply with division (B) of this section in any of the following ways:
(1) By providing the benefits under a health insuring corporation contract issued in accordance with Chapter 1751. of the Revised Code or a policy of sickness and accident insurance issued in accordance with Chapter 3923. of the Revised Code;
(2) By reimbursing the employee for the direct health care provider charges associated with receipt of the covered service;
(3) By making any other arrangement that provides the benefits described in division (B) of this section.
(D) The benefits provided under division (B)(1) of this section shall cover expenses in accordance with all of the following:
(1) If a woman is at least thirty-five years of age but under forty years of age, one screening mammography;
(2) If a woman is at least forty years of age but under fifty years of age, either of the following:
(a) One screening mammography every two years;
(b) If a licensed physician has determined that the woman has risk factors to breast cancer, one screening mammography every year.
(3) If a woman is at least fifty years of age but under sixty-five years of age, one screening mammography every year.
(E) As used in this division, "medicare reimbursement rate" means the reimbursement rate paid in this state under the medicare program for screening mammography that does not include digitization or computer-aided detection, regardless of whether the actual benefit includes digitization or computer-aided detection.
(1) Subject to divisions (E)(2) and (3) of this section, if a provider, hospital, or other health care facility provides a service that is a component of the screening mammography benefit in division (B)(1) of this section and submits a separate claim for that component, a separate payment shall be made to the provider, hospital, or other health care facility in an amount that corresponds to the ratio paid by medicare in this state for that component.
(2) Regardless of whether separate payments are made for the benefit provided under division (B)(1) of this section, the total benefit for a screening mammography need not exceed one hundred thirty per cent of the medicare reimbursement rate in this state for screening mammography. If there is more than one medicare reimbursement rate in this state for screening mammography or a component of a screening mammography, the reimbursement limit shall be one hundred thirty per cent of the lowest medicare reimbursement rate in this state.
(3) The benefit paid in accordance with division (E)(1) of this section shall constitute full payment. No provider, hospital, or other health care facility shall seek or receive compensation in excess of the payment made in accordance with division (E)(1) of this section, except for approved deductibles and copayments.
(F) The benefits provided under division (B)(1) of this section shall be provided only for screening mammographies that are performed in a facility or mobile mammography screening unit that is accredited under the American college of radiology mammography accreditation program or in a hospital as defined in section 3727.01 of the Revised Code.
(G) The benefits provided under division (B)(2) of this section shall be provided only for cytologic screenings that are processed and interpreted in a laboratory certified by the college of American pathologists or in a hospital as defined in section 3727.01 of the Revised Code.
Structure Ohio Revised Code
Chapter 3923 | Sickness and Accident Insurance
Section 3923.01 | Policy of Sickness and Accident Insurance Defined.
Section 3923.011 | Sickness and Accident Insurance Definitions.
Section 3923.02 | Form of Policy Filed With Superintendent.
Section 3923.021 | Approval or Disapproval of Premium Rates.
Section 3923.022 | Maximum Aggregate Administrative Expenses.
Section 3923.03 | Necessary Provisions.
Section 3923.04 | Policy Standard Provisions.
Section 3923.041 | Policies With Prior Authorization Requirement Provisions.
Section 3923.05 | Provisions to Conform to Prescribed Wording.
Section 3923.06 | Order of Presentation of Policy Provisions.
Section 3923.061 | Interest on Proceeds Payable Due to Death by Sickness or Accident.
Section 3923.07 | Omission or Substitution of Provisions.
Section 3923.071 | Policies, Applications, Riders or Indorsements Issued Prior to 10-1-53.
Section 3923.08 | Nonconflicting Provisions Permitted in Policy.
Section 3923.09 | Validity of Nonconforming Policy.
Section 3923.10 | Industrial Sickness and Accident Insurance.
Section 3923.11 | Sickness and Accident Insurance on a Franchise Plan.
Section 3923.12 | Group Sickness and Accident Insurance.
Section 3923.121 | Association of Insurers to Provide Basic Medical Coverage to Persons 65 or Older.
Section 3923.13 | Blanket Sickness and Accident Insurance.
Section 3923.14 | False Statement in Application - Alteration of Written Application.
Section 3923.141 | Agent of the Insurer.
Section 3923.15 | Unfair Discrimination Prohibited.
Section 3923.16 | Misleading or Deceptive Advertising Prohibited.
Section 3923.17 | Prohibition of Rebates Not to Prohibit Commissions or Dividends.
Section 3923.18 | Rights of Insurer in Defense of Claim Not Waived.
Section 3923.19 | Benefits Exempt From Legal Process - Exception.
Section 3923.20 | Exemptions for Certain Insurance Policies.
Section 3923.21 | Prohibition Against Delivery of Policy on Disapproved Insurance Form.
Section 3923.22 | Appeal - Applicability of Administrative Procedure Sections.
Section 3923.231 | Reimbursement for Services of Licensed Psychologist.
Section 3923.232 | Reimbursement for Services of Licensed Dentist.
Section 3923.234 | Reimbursement for Services of Certified Mechanotherapist.
Section 3923.24 | Continuing Coverage for Dependent Children.
Section 3923.241 | Public Employee Benefit Plans - Continuing Coverage for Dependent Children.
Section 3923.25 | Kidney Dialysis Benefits.
Section 3923.26 | Coverage for Newly Born Children From the Moment of Birth.
Section 3923.27 | Hospitalization Coverage for Mental Illness.
Section 3923.28 | Outpatient Coverage for Mental or Emotional Disorders.
Section 3923.281 | Sickness and Accident Policies - Biologically Based Mental Illness.
Section 3923.282 | Health Coverage Plans - Biologically Based Mental Illness.
Section 3923.29 | Outpatient, Inpatient, and Intermediate Primary Care Benefits for Alcoholism.
Section 3923.31 | Right to Rescind Individual Policy of Sickness and Accident Insurance.
Section 3923.33 | Medicare Supplement Policy Definitions.
Section 3923.331 | Statutes Applicable to Medicare Supplement Policies.
Section 3923.332 | Standards for Policy Provisions of Medicare Supplement Policies and Certificates.
Section 3923.333 | Benefits to Be Reasonable in Relation to Premium Charged.
Section 3923.334 | Outline of Coverage Delivered at Time Application Is Made.
Section 3923.335 | Right to Return Policy or Certificate and Have Premium Refunded.
Section 3923.336 | Review and Approval of Advertisement by Superintendent.
Section 3923.338 | Orders of Superintendent.
Section 3923.339 | Severability.
Section 3923.36 | Excluding Coverage of Illness or Injury Covered by Workers' Compensation.
Section 3923.38 | Continuing Policy Upon Termination of Employment.
Section 3923.39 | Consolidated Corporation Cancelling Individual Policy for Nonpayment.
Section 3923.40 | Coverage of Adopted Children.
Section 3923.41 | Long-Term Care Insurance Definitions.
Section 3923.42 | Citing Provisions - Applicability.
Section 3923.43 | Evidence to Be Filed by Long-Term Care Insurance Association.
Section 3923.441 | Rescission of Long-Term Care Policy for Misrepresentation.
Section 3923.442 | Offer of Nonforfeiture Benefit Option With Long-Term Care Policy.
Section 3923.443 | Training Required for Agents Selling Long-Term Care Policies.
Section 3923.444 | Compensation of Agents Selling Long-Term Care Policies.
Section 3923.46 | Rates for Individual Policy.
Section 3923.48 | Violation Is Unfair and Deceptive Insurance Practice.
Section 3923.49 | Establishing Outreach Program to Educate Consumers.
Section 3923.52 | Screening Mammography and Cytologic Screening Benefits.
Section 3923.53 | Public Employee Benefit Plan - Breast Cancer and Cervical Cancer Screening.
Section 3923.54 | Employee Health Care Benefit Plan.
Section 3923.57 | Pre-Existing Conditions Provisions.
Section 3923.60 | Standard Medical Reference Compendia for Coverage of Prescription Drugs.
Section 3923.602 | Medication Synchronization for Insured.
Section 3923.61 | Public Employee Benefit Plans - Prescription Drugs.
Section 3923.62 | Disclosing Determination of Usual and Customary Fee for Dental Benefits.
Section 3923.63 | Coverage of Inpatient Care and Follow-Up Care for Mother and Her Newborn.
Section 3923.64 | Public Employee Benefit Plans - Maternity Benefits.
Section 3923.65 | Coverage for Emergency Services.
Section 3923.80 | Denial of Coverage to Cancer Clinical Trial Participant.
Section 3923.81 | Covered Person's Payments Not to Exceed Insurer Payments.
Section 3923.82 | Coverage for Alcohol or Drug Related Losses or Expenses.
Section 3923.84 | Coverage for Autism Spectrum Disorder.
Section 3923.85 | Cancer Medication; Coverage for Orally and Intravenously Administered Treatments.
Section 3923.86 | Statement Provided to Insureds Under Vision Policy.
Section 3923.87 | Compliance With Section 3959.20.
Section 3923.89 | Payment or Reimbursement to Pharmacist.