2006 Ohio Revised Code - 3923. Sickness and Accident Insurance.

• 3923.01. Policy of sickness and accident insurance defined.
• · · · [3923.01.1] 3923.011.Policy terms defined.
• 3923.02. Form of policy filed with superintendent.
• · · · [3923.02.1] 3923.021.Public hearings on rates.
• · · · [3923.02.2] 3923.022.Annual limit on administrative expenses as percentage of premium income.
• 3923.03. Necessary provisions.
• 3923.04. Standard provisions.
• · · · [3923.04.1] 3923.041.[Repealed]
• 3923.05. Optional standard provisions.
• 3923.06. Additional provisions for policies.
• · · · [3923.06.1] 3923.061.Interest on proceeds payable due to death.
• 3923.07. Omission or substitution of provisions.
• · · · [3923.07.1] 3923.071.Extension of delivery or issue date.
• 3923.08. Nonconflicting provisions permitted in policy.
• 3923.09. Validity of nonconforming policy.
• 3923.10. Industrial sickness and accident insurance.
• 3923.11. Sickness and accident insurance on a franchise plan.
• 3923.12. Group sickness and accident insurance.
• · · · [3923.12.1] 3923.121.Association of group sickness and accident insurers; coverage for residents 65 years of age or older; powers of superintendent.
• · · · [3923.12.2] 3923.122.Option for conversion to individual policy or basic or standard plan.
• · · · [3923.12.3] 3923.123.Insurers association to provide group coverage for qualified unemployed persons.
• 3923.13. Blanket sickness and accident insurance.
• 3923.14. False statement in application; alteration of application.
• · · · [3923.14.1] 3923.141.Agent of the insurer.
• 3923.15. Unfair discrimination prohibited.
• 3923.16. Misleading or deceptive advertising prohibited.
• · · · [3923.16.1] 3923.161.Reference in advertising to noncancellation provisions.
• 3923.17. Prohibition of rebates not to prohibit commissions or dividends.
• 3923.18. Rights of insurer in defense of claim not waived.
• 3923.19. Benefits exempt from legal process; exception.
• 3923.20. Certain policies exempted.
• 3923.21. Suspension of business or license, revocation of license.
• 3923.22. Appeal; applicability of administrative procedure sections.
• 3923.23. Reimbursement of licensed osteopath, optometrist, chiropractor or podiatrist.
• · · · [3923.23.1] 3923.231.Reimbursement of psychologist.
• · · · [3923.23.2] 3923.232.Reimbursement for practice of dentistry.
• · · · [3923.23.3] 3923.233.Reimbursement of nurse-midwife and supervising physician.
• · · · [3923.23.4] 3923.234.Reimbursement for services of certain mechanotherapists.
• 3923.24. Continuation of medical care for dependent children.
• 3923.25. Kidney dialysis benefits, out-patient basis.
• 3923.26. Coverage for newly born children.
• 3923.27. Contents of policy providing hospitalization for mental illness.
• 3923.28. Outpatient benefits for mental or emotional disorders; review plans.
• 3923.29. Alcoholism coverage; review plans; rehabilitation program.
• 3923.30. Outpatient benefits for mental or emotional disorders; alcoholism coverage.
• · · · [3923.30.1] 3923.301.Employee health care benefits to include nurse-midwife services.
• 3923.31. Policyholder's right to rescind individual policy within ten days.
• 3923.32. Family members' right to continue coverage after subscriber's death or upon change in marital relation to subscriber.

Medicare Supplement Policies.

• 3923.33. Definitions.
• · · · [3923.33.1] 3923.331.Application of provisions.
• · · · [3923.33.2] 3923.332.Prohibited policy provisions; standards; rules.
• · · · [3923.33.3] 3923.333.Benefits paid to be reasonable in relation to charges.
• · · · [3923.33.4] 3923.334.Outline of coverage to be delivered at time of application; informational brochure; disclosures by insurers.
• · · · [3923.33.5] 3923.335.Notice of right to return policy and receive refund.
• · · · [3923.33.6] 3923.336.Prior review and approval of advertising.
• · · · [3923.33.7] 3923.337.Procedure for adopting rules.
• · · · [3923.33.8] 3923.338.Additional remedies for violations.
• · · · [3923.33.9] 3923.339.Severability of provisions.
• 3923.36. Effect of failure to elect workers' compensation coverage.
• 3923.37. Supplemental sickness and accident policy not to affect benefits.
• 3923.38. Employee's privilege to continue coverage upon termination of employment.
• · · · [3923.38.1] 3923.381.Eligible person may continue coverage where reservist is called or ordered to active duty.
• · · · [3923.38.2] 3923.382.Eligible person may continue coverage under employer self-insurance plan where reservist is called or ordered to active duty.
• 3923.39. Consolidated corporation may cancel individual policy for nonpayment; unnecessary services; medicare supplements.
• 3923.40. Coverage of adopted children.

Long-Term Care Insurance.

• 3923.41. Definitions.
• 3923.42. Citation of act; application of provisions.
• 3923.43. [Repealed]
• 3923.44. Rules for sale of long-term care insurance; policy requirements; outline of coverage.
• 3923.45. Forms.
• 3923.46. Individual rates.
• 3923.47. Rules.
• 3923.48. Violations.
• 3923.49. Outreach program to educate consumers about long-term care insurance.
• 3923.50. Notice to department of job and family services of policies meeting requirements; rules for qualification.
• 3923.51. Group coverage for youths from lower income families.

Mammography, Screening for Cervical Cancer.

• 3923.52. Insurance benefits for screening mammography; cytologic screening for cervical cancer.
• 3923.53. Public employee benefit plan coverage.
• 3923.54. Employee health care plan coverage.

Child Health Supervision.

• 3923.55. Benefits for child health supervision services from birth to age nine.
• 3923.56. Employee benefit plan coverage for child health supervision services.
• 3923.57. Limitations on pre-existing conditions provisions; policyholder's right of renewal.
• · · · [3923.57.1] 3923.571.Conditions applicable to employment-related group policies.
• 3923.58. Acceptance of applicants for open enrollment coverage via individual policy.
• · · · [3923.58.1] 3923.581.Open enrollment duties of carriers providing individual or nonemployer group coverage.
• 3923.59. Open enrollment reinsurance program.

Prescription Drug Coverage Prohibitions.

• 3923.60. Limiting or excluding prescription drug coverage based on lack of federal approval for particular indication prohibited.
• · · · [3923.60.1] 3923.601.Standardized identification card or electronic technology used for prescription drug claims to contain uniform information.
• 3923.61. Public employee benefit plans.
• 3923.62. Disclosure of usual and customary fee information for dental benefits.
• 3923.63. Maternity benefits to include inpatient and follow-up care minimums; early discharge decisions; prohibitions.
• 3923.64. Public employee maternity benefits.
• 3923.65. Coverage for emergency services.
• · · · [3923.65.1] 3923.651.[Repealed]

Review of Health Care Service Denials.

• 3923.66. Requests for review of denial of coverage of health care services.
• 3923.67. Opportunity for external review.
• 3923.68. External, independent review of coverage of insureds with terminal conditions.
• · · · [3923.68.1] 3923.681.Sanctions for insurer's noncompliance; conference with suspected violator; cease and desist orders; actions by attorney general.
• 3923.69. Causes of action not created.
• 3923.70. Independent review organization's decision or opinion and medicare reimbursement standards as evidence.

Review of Public Employee Benefit Plan Coverage Denials.

• 3923.75. Requests for review of denials of coverage of health care services.
• 3923.76. Opportunity to request external review of coverage denial; decision of independent review organization.
• 3923.77. External review of coverage of plan members with terminal conditions.
• 3923.78. Causes of action not created.
• 3923.79. Independent review organization's decision or opinion and medicare reimbursement standards as evidence.
• 3923.83. Standardized identification card or electronic technology used for prescription drug claims to contain uniform information.
• 3923.99. Penalty.