Effective: March 23, 2015
Latest Legislation: House Bill 201 - 130th General Assembly
(A) As used in this section:
(1) "Emergency medical condition" means a medical condition that manifests itself by such acute symptoms of sufficient severity, including severe pain, that a prudent layperson with average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in any of the following:
(a) Placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy;
(b) Serious impairment to bodily functions;
(c) Serious dysfunction of any bodily organ or part.
(2) "Emergency services" means the following:
(a) A medical screening examination, as required by federal law, that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department, to evaluate an emergency medical condition;
(b) Such further medical examination and treatment that are required by federal law to stabilize an emergency medical condition and are within the capabilities of the staff and facilities available at the hospital, including any trauma and burn center of the hospital.
(B) Every individual or group policy of sickness and accident insurance that provides hospital, surgical, or medical expense coverage shall cover emergency services without regard to the day or time the emergency services are rendered or to whether the policyholder, the hospital's emergency department where the services are rendered, or an emergency physician treating the policyholder, obtained prior authorization for the emergency services.
(C) Every individual policy or certificate furnished by an insurer in connection with any sickness and accident insurance policy shall provide information regarding the following:
(1) The scope of coverage for emergency services;
(2) The appropriate use of emergency services, including the use of the 9-1-1 system and any other telephone access systems utilized to access prehospital emergency services;
(3) Any copayments for emergency services.
(D) This section does not apply to any individual or group policy of sickness and accident insurance covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, medicare, tricare, specified disease, or vision care; coverage under a one-timelimitedduration policy that is less than twelve months; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar law; automobile medical payment insurance; or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
Last updated November 22, 2021 at 5:00 PM
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.