Ohio Revised Code Chapter 1751 - Health Insuring Corporation Law

• Section 1751.01 - Health Insuring Corporation Law Definitions.
  As used in this chapter: (A) (1) "Basic health care services" means the following services when medically necessary: (a) Physician's services, except when such...
• Section 1751.02 - Applying For Certificate Of Authority.
  (A) Notwithstanding any law in this state to the contrary, any corporation, as defined in section 1751.01 of the Revised Code, may apply to...
• Section 1751.03 - Verification Of Application.
  (A) Each application for a certificate of authority under this chapter shall be verified by an officer or authorized representative of the applicant, shall...
• Section 1751.04 - Review Of Application And Documents By Superintendent.
  (A) Except as provided by division (D) of this section, upon the receipt by the superintendent of insurance of a complete application for a...
• Section 1751.05 - Issuance Or Denial Of Certificate Of Authority.
  (A) The superintendent of insurance shall issue or deny a certificate of authority to a health insuring corporation filing an application pursuant to section...
• Section 1751.06 - Powers Upon Obtaining Certificate.
  Upon obtaining a certificate of authority as required under this chapter, a health insuring corporation may do all of the following: (A) Enroll individuals...
• Section 1751.07 - Responsibility For Funds.
  Any trustee, director, officer, or employee of a health insuring corporation who receives, collects, disburses, or invests funds in connection with the activities of...
• Section 1751.08 - Inapplicability Of Insurance Laws.
  (A) Except as otherwise specifically provided in this chapter or Title XXXIX [39] of the Revised Code, provisions of Title XXXIX [39] of the...
• Section 1751.11 - Evidence Of Coverage.
  (A) Every subscriber of a health insuring corporation is entitled to an evidence of coverage for the health care plan under which health care...
• Section 1751.111 - Standardized Prescription Identification Information - Pharmacy Benefits To Be Included.
  (A) (1) This section applies to both of the following: (a) A health insuring corporation that issues or requires the use of a standardized...
• Section 1751.12 - Contractual Periodic Prepayment Or Premium Rate.
  (A) (1) No contractual periodic prepayment and no premium rate for nongroup and conversion policies for health care services, or any amendment to them,...
• Section 1751.13 - Contracts With Providers And Health Care Facilities.
  (A) (1) (a) A health insuring corporation shall, either directly or indirectly, enter into contracts for the provision of health care services with a...
• Section 1751.14 - Termination Of Coverage Of Child.
  (A) Notwithstanding section 3901.71 of the Revised Code, any policy, contract, or agreement for health care services authorized by this chapter that is issued,...
• Section 1751.141 - Dependent Children Living Outside Health Insuring Corporation's Approved Service Area.
  A health insuring corporation shall provide coverage, in accordance with the terms of the contract, for a subscriber's dependent children living outside the health...
• Section 1751.15 - [Suspended Eff. 1/1/2014 Through 1/1/2018; See Note] Annual Open Enrollment Period.
  (A) Each health insuring corporation shall accept individuals for open enrollment coverage as provided in sections 3923.58 and 3923.581 of the Revised Code. A...
• Section 1751.16 - [Suspended Eff. 1/1/2014 Through 1/1/2018; See Note] Option For Conversion From Group To Individual Contract.
  (A) Except as provided in division (F) of this section, every group contract issued by a health insuring corporation shall provide an option for...
• Section 1751.17 - [Suspended Eff. 1/1/2014 Through 1/1/2018; See Note] Option For Conversion To A Contract Issued On A Direct-payment Basis.
  (A) As used in this section, "nongroup contract" means a contract issued by a health insuring corporation to an individual who makes direct application...
• Section 1751.18 - Cancelling Or Failing To Renew Coverage.
  (A) (1) No health insuring corporation shall cancel or fail to renew the coverage of a subscriber or enrollee because of any health status-related...
• Section 1751.19 - Complaint System.
  (A) A health insuring corporation shall establish and maintain a complaint system that has been approved by the superintendent of insurance to provide adequate...
• Section 1751.20 - Unfair, Untrue, Misleading, Or Deceptive Acts.
  (A) No health insuring corporation, or agent, employee, or representative of a health insuring corporation, shall use any advertisement or solicitation document, or shall...
• Section 1751.21 - Peer Review Committee.
  (A) A peer review committee of a hospital or other health care facility or provider, or of an intermediary organization or health delivery network,...
• Section 1751.25 - Investment Of Funds.
  (A) Except as provided in division (B) of this section, the funds of a health insuring corporation shall be invested only in securities or...
• Section 1751.26 - Investments In Real Estate.
  (A) For purposes of this section, real estate used for "the accommodation of the health insuring corporation's business operations" includes the health insuring corporation's...
• Section 1751.27 - Deposit Of Securities With Superintendent Or Custodian.
  (A) Each health insuring corporation holding a certificate of authority to operate in this state shall have deposited securities with the superintendent of insurance...
• Section 1751.271 - Medicaid Providers - Performance Bond.
  (A) Each health insuring corporation that provides coverage to medicaid recipients shall post a performance bond in the amount of three million dollars as...
• Section 1751.28 - Admitted Assets Held In Corporation's Name And Free And Clear Of Encumbrances, Pledges, Or Hypothecation.
  (A) (1) Every health insuring corporation authorized to provide basic health care services, which health insuring corporation is not a provider sponsored organization, shall...
• Section 1751.31 - Changes In Corporation's Solicitation Document.
  (A) Any changes in a health insuring corporation's solicitation document shall be filed with the superintendent of insurance thirty days prior to use for...
• Section 1751.32 - Annual Report.
  Each health insuring corporation, annually, on or before the first day of March, shall file a report with the superintendent of insurance , covering...
• Section 1751.321 - Audit Report Filed Annually.
  Each health insuring corporation, annually, on or before the first day of June, shall file with the superintendent of insurance an audit report certified...
• Section 1751.33 - Information To Be Provided To Subscribers.
  (A) Each health insuring corporation shall provide to its subscribers a description of the health insuring corporation, its method of operation, its service area,...
• Section 1751.34 - Examinations By Superintendent And Director.
  (A) Each health insuring corporation and each applicant for a certificate of authority under this chapter shall be subject to examination by the superintendent...
• Section 1751.35 - Suspension Or Revocation Of Certificate Of Authority.
  (A) The superintendent of insurance may suspend or revoke any certificate of authority issued to a health insuring corporation under this chapter if the...
• Section 1751.36 - Notification Of Grounds For Denial, Suspension Or Revocation Of Certificate - Hearing.
  (A) When the superintendent of insurance has cause to believe that grounds for the denial of an application for a certificate of authority exist,...
• Section 1751.38 - Applicability Of Other Laws.
  (A) As used in this section, "agent" means a person appointed by a health insuring corporation to engage in the solicitation or enrollment of...
• Section 1751.40 - Insurance Companies Operating As Health Insuring Corporations.
  (A) Notwithstanding any provision of Title XXXIX [39] of the Revised Code, any insurance company holding a certificate of authority issued pursuant to Title...
• Section 1751.42 - Rehabilitation, Liquidation, Supervision Or Conservation Of Corporation.
  Any rehabilitation, liquidation, supervision, or conservation of a health insuring corporation shall be deemed to be the rehabilitation, liquidation, supervision, or conservation of an...
• Section 1751.44 - Fees Paid To Superintendent Of Insurance.
  (A) Each health insuring corporation shall pay to the superintendent of insurance the following fees: (1) For filing an application for a certificate of...
• Section 1751.45 - Administrative Penalties - Violations.
  (A) In lieu of the suspension or revocation of a certificate of authority under section 1751.35 of the Revised Code, the superintendent of insurance,...
• Section 1751.46 - Recommendations For Expansion Of Service Areas.
  (A) The superintendent of insurance may contract with qualified persons to make recommendations concerning the determinations required to be made by the superintendent relative...
• Section 1751.47 - Adopting Forms, Instructions And Manuals For Providing Financial Information.
  (A) The superintendent of insurance shall adopt the forms, instructions, and manuals prescribed by the national association of insurance commissioners for the preparation and...
• Section 1751.48 - Rules.
  The superintendent of insurance may adopt rules as are necessary to carry out the provisions of this chapter. These rules shall be adopted in...
• Section 1751.51 - Restrictions On Choice Of Providers.
  If a health care plan of a health insuring corporation covers health care services that may be legally performed by a class of providers...
• Section 1751.52 - Confidentiality Of Information.
  (A) All applications, filings, and reports required under this chapter shall be treated as public documents after the date the application, filing, or report...
• Section 1751.521 - Medical Information Release.
  If an enrollee signs a medical information release upon the request of a health insuring corporation, the release shall clearly explain what information may...
• Section 1751.53 - Continuing Coverage After Termination Of Employment.
  (A) As used in this section: (1) "Group contract" means a group health insuring corporation contract covering employees that meets either of the following...
• Section 1751.54 - Continuing Coverage After Reservist Called To Duty.
  (A) As used in this section: (1) "Eligible person" means any person who, at the time a reservist is called or ordered to active...
• Section 1751.55 - Effect Of Workers Compensation Coverage.
  A health insuring corporation policy, contract, or agreement shall not be construed to exclude illness or injury upon the ground that the subscriber might...
• Section 1751.56 - Effect Of Supplemental Sickness And Accident Insurance Policy.
  (A) No individual or group health insuring corporation policy, contract, or agreement shall be delivered, issued for delivery, or renewed in this state, if...
• Section 1751.57 - Conditions Applying To All Individual Health Insuring Corporation Contracts.
  (A) The following conditions apply to all individual health insuring corporation contracts: (1) Except as provided in section 2742(b) to (e) of the "Health...
• Section 1751.58 - Conditions Applying To All Group Health Insuring Corporation Contracts Sold In Connection With Employment-related Group Health Care Plan.
  Except as otherwise provided in section 2721 of the "Health Insurance Portability and Accountability Act of 1996," Pub. L. No. 104-191 , 110 Stat....
• Section 1751.59 - Coverage Of Adopted Children.
  No individual or group health insuring corporation policy, contract, or agreement that makes family coverage available may be delivered, issued for delivery, or renewed...
• Section 1751.60 - Provider Or Facility Limited To Seek Compensation For Covered Services Solely From Hic.
  (A) Except as provided for in divisions (E) and (F) of this section, every provider or health care facility that contracts with a health...
• Section 1751.61 - Coverage For Newly Born Child.
  (A) Each individual or group evidence of coverage that is delivered, issued for delivery, or renewed by a health insuring corporation in this state,...
• Section 1751.62 - Screening Mammography - Cytologic Screening For Cervical Cancer.
  (A) As used in this section: (1) "Screening mammography" means a radiologic examination utilized to detect unsuspected breast cancer at an early stage in...
• Section 1751.63 - Long-term Care Insurance.
  Sections 3923.41 to 3923.48 of the Revised Code apply to every health insuring corporation that offers long-term care and that holds a certificate of...
• Section 1751.64 - [Repealed].
  Effective Date: 06-30-1997; repealed effective 02-09-2014
• Section 1751.65 - Health Insuring Corporation - Prohibited Activities.
  (A) As used in this section, "genetic screening or testing" means a laboratory test of a person's genes or chromosomes for abnormalities, defects, or...
• Section 1751.66 - Prescription Drugs.
  (A) No individual or group health insuring corporation policy, contract, or agreement that provides coverage for prescription drugs shall limit or exclude coverage for...
• Section 1751.67 - Maternity Benefits.
  (A) Each individual or group health insuring corporation policy, contract, or agreement delivered, issued for delivery, or renewed in this state that provides maternity...
• Section 1751.68 - [Repealed].
  Effective Date: 10-16-2005
• Section 1751.69 - Cancer Chemotherapy; Coverage For Orally And Intravenously Administered Treatments.
  (A) As used in this section, "cost sharing" means the cost to an individual insured under an individual or group health insuring corporation policy,...
• Section 1751.70 - Authorization Of Payroll Deductions For Public Employees.
  (A) An employee of the state, of any political subdivision of the state, or of any institution supported in whole or in part by...
• Section 1751.71 - Accepting Payments For Cost Of Policies, Contracts, And Agreements.
  Each health insuring corporation subject to this chapter may accept from governmental agencies, or from private persons, payments covering all or part of the...
• Section 1751.73 - Implementing Quality Assurance Programs.
  Each health insuring corporation providing basic health care services shall implement a quality assurance program for use in connection with those policies, contracts, and...
• Section 1751.74 - Quality Assurance Program Requirements.
  (A) To implement a quality assurance program required by section 1715.73 of the Revised Code, a health insuring corporation shall do both of the...
• Section 1751.75 - Determination That Accreditation Constitutes Compliance.
  A health insuring corporation may present evidence of compliance with the requirements of sections 1751.73 and 1751.74 of the Revised Code by submitting certification...
• Section 1751.77 - Utilization Review, Internal And External Review Procedure Definitions.
  As used in sections 1751.77 to 1751.87 of the Revised Code, unless otherwise specifically provided or as otherwise required pursuant to applicable federal law...
• Section 1751.78 - Application Of Provisions.
  (A) (1) Sections 1751.77 to 1751.87 and Chapter 3922. of the Revised Code apply to any health insuring corporation that provides or performs utilization...
• Section 1751.79 - Utilization Review Program Requirements.
  A health insuring corporation that conducts utilization review shall prepare a written utilization review program that describes all review activities, both delegated and nondelegated,...
• Section 1751.80 - Implementing Utilization Review Programs.
  The utilization review program of a health insuring corporation shall be implemented in accordance with all of the following: (A) The program shall use...
• Section 1751.81 - Maintaining Written Procedures For Determining Whether Requested Service Is Covered.
  (A) As used in this section, "necessary information" includes the results of any face-to-face clinical evaluation or second opinion that may be required. (B)...
• Section 1751.811 - Internal And External Reviews.
  In lieu of conducting a prospective, concurrent, or retrospective review under section 1751.81 of the Revised Code, providing a reconsideration under section 1751.82 of...
• Section 1751.82 - Reconsideration Of Adverse Determination.
  (A) In a case involving a prospective determination or a concurrent review determination, a health insuring corporation shall give the provider or health care...
• Section 1751.821 - Determination That Accreditation Constitutes Compliance.
  A health insuring corporation may present evidence of compliance with the requirements of sections 1751.77 to 1751.82 of the Revised Code by submitting evidence...
• Section 1751.822 - Cooperation With Utilization Review Program.
  Each participating provider or health care facility submitting a claim shall cooperate with the utilization review program of a health insuring corporation or utilization...
• Section 1751.823 - Filing Certificate Of Compliance.
  A health insuring corporation shall annually file a certificate with the superintendent of insurance certifying its compliance with sections 1751.77 to 1751.82 of the...
• Section 1751.83 - Maintaining Internal Review System.
  A health insuring corporation shall establish and maintain an internal review system that has been approved by the superintendent of insurance. The system shall...
• Section 1751.831 - [Repealed].
  Repealed by 129th General AssemblyFile No.48, HB 218, §2, eff. 12/26/2011. Amended by 128th General AssemblyFile No.9, HB 1, §101.01, eff. 10/16/2009. Effective Date:
• Section 1751.84 - [Repealed].
  Repealed by 129th General AssemblyFile No.48, HB 218, §2, eff. 12/26/2011. Amended by 128th General AssemblyFile No.9, HB 1, §101.01, eff. 10/16/2009. Effective Date:
• Section 1751.85 - [Repealed].
  Repealed by 129th General AssemblyFile No.48, HB 218, §2, eff. 12/26/2011. Amended by 128th General AssemblyFile No.9, HB 1, §101.01, eff. 10/16/2009. Effective Date:
• Section 1751.86 - Violation Deemed Unfair And Deceptive Act Or Practice.
  (A) No health insuring corporation shall fail to comply with sections 1751.77 to 1751.82 of the Revised Code. (B) Whoever violates division (A) of...
• Section 1751.87 - Cause Of Action Not Created.
  Nothing in sections 1751.77 to 1751.83 of the Revised Code shall be construed to create a cause of action against an employer that provides...
• Section 1751.88 - [Repealed].
  Repealed by 129th General AssemblyFile No.48, HB 218, §2, eff. 12/26/2011. Effective Date: 05-01-2000
• Section 1751.89 - Medicare And Medicaid Exceptions.
  Sections 1751.77 to 1751.83 of the Revised Code do not apply to either of the following: (A) Coverage provided to beneficiaries enrolled in the...

Last modified: October 10, 2016