Title 39, Insurance

(A) On and after July 1, 2027, a pharmacy benefit manger shall do all of the following: (1) Maintain relevant books and records that reflect all transactions administered by the pharmacy benefit manager pursuant to agreements that are subject to this chapter, specifically in rega…

(A) All information and data acquired by the superintendent of insurance or the department of insurance under this chapter is considered proprietary and confidential under section 3905.24 of the Revised Code and is not a public record under section 149.43 of the Revised Code. (B)…

For purposes of licensure, this chapter does not apply to an employer's self-insurance program or fully insured plan to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes its application to such plan.

On receipt of a notice pursuant to section 3123.43 of the Revised Code, the superintendent of insurance shall comply with sections 3123.41 to 3123.50 of the Revised Code and any applicable rules adopted under section 3123.63 of the Revised Code with respect to a license issued pu…

(A)(1)(a) In each contract between a pharmacy benefit manager and a pharmacy, the pharmacy shall be given the right to obtain from the pharmacy benefit manager, within ten days after any request, a current list of the sources used to determine maximum allowable cost pricing. In e…

(A) As used in this section and section 3957.27 of the Revised Code: (1) "Administrator" has the same meaning as in section 3959.01 of the Revised Code. (2) "Cost-sharing" means the cost to an individual insured under a health benefit plan according to any coverage limit, copayme…

No health plan issuer, pharmacy benefit manager, or any other administrator shall prohibit a pharmacy from mailing or delivering drugs to patients as an ancillary service.

Whoever knowingly violates section 3957.03 of the Revised Code is guilty of a misdemeanor of the fourth degree.

As used in this chapter: (A) "Administration fees" means any amount charged a covered person for services rendered. "Administration fees" includes commissions earned or paid by any person relative to services performed by an administrator. (B) "Administrator" means any person who…

(A) Administrators may be tested and shall be licensed by the superintendent of insurance in accordance with rules adopted by the superintendent. (B) An administrator who has been licensed or certified by the state of the administrator's domicile under a statute or rule similar t…

No person shall solicit a plan or sponsor of a plan to act as an administrator for, or provide administrative services to, a plan or sponsor of a plan that is either domiciled in this state or has its principal headquarters or principal administrative office in this state unless …

(A) An administrator shall file with the superintendent of insurance an application for a license on a form prescribed by the superintendent. (B) All applications for a license shall be accompanied by a nonrefundable filing fee of two hundred dollars per application made payable …

The superintendent of insurance shall act on all applications submitted for a license within thirty days after receipt.

If the superintendent of insurance denies the application for license, the superintendent shall promptly notify the applicant of the denial and the reasons for the denial within thirty days of the date the application is denied by the superintendent. The notice shall advise the a…

Upon approval of the application for an administrators license and payment of appropriate filing fees, the applicant shall be granted a license by the superintendent of insurance and an appropriate certificate of authority to operate as an administrator will be issued to the appl…

(A) The superintendent of insurance shall, at least sixty days before the expiration of the administrators license granted by the superintendent, provide a renewal notice on a form approved by the superintendent. (B) The renewal application shall require the payment of a renewal …

(A) No person may act as an administrator without a written agreement between the administrator and the plan sponsor. Such written agreement shall be retained as part of the official records of the administrator for the duration of the agreement and for five years thereafter. Eac…

(A) Any license issued under sections 3959.01 to 3959.16 of the Revised Code may be suspended for a period not to exceed two years, revoked, or not renewed by the superintendent of insurance after notice to the licensee and hearing in accordance with Chapter 119. of the Revised C…

Any person who, while licensed as an administrator, is convicted of a felony, shall report the conviction to the superintendent of insurance within thirty days of the entry date of the judgment of conviction. Within that thirty-day period, the person shall also provide the superi…

No administrator shall do any of the following: (A) Use plan sponsor funds for any purpose or purposes not specifically set forth in written form by the administrator; (B) Fail to disclose in written solicitation material and on an on-going basis, at least once annually, to the p…

(A) Administrators shall maintain detailed books and records that reflect all administered transactions specifically in regard to premiums or contributions received and deposited and claims and authorized expenses paid. (B) The detailed preparation, journalizing, and posting of s…

Sections 3959.01 to 3959.16 of the Revised Code do not apply to an employer's self-insurance plan to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of any provisions of those sections to such plan.

On receipt of a notice pursuant to section 3123.43 of the Revised Code, the superintendent of insurance shall comply with sections 3123.41 to 3123.50 of the Revised Code and any applicable rules adopted under section 3123.63 of the Revised Code with respect to a license issued pu…

A person who violates section 3959.05 of the Revised Code is guilty of a misdemeanor of the fourth degree.

As used in sections 3960.01 to 3960.13 of the Revised Code: (A) "Completed operations liability" means liability arising out of the installation, maintenance, or repair of any product at a site that is not owned or controlled by either a person who performs that work or a person …

(A) No risk retention group organized under the laws of this state shall transact business in this state unless both of the following apply: (1) It has capital and surplus in an amount of not less than two million five hundred thousand dollars, and the superintendent of insurance…

All of the following apply to risk retention groups chartered and licensed in states other than this state, that seek to do business as a risk retention group in this state: (A) No risk retention group shall offer insurance in this state unless it has submitted to the superintend…

(A)(1) Every application form for insurance from a risk retention group and every policy or certificate of insurance issued by a risk retention group shall contain in ten-point type on the front page and the declaration page, the following notice: "Notice This policy is issued by…

(A) Sections 3955.01 to 3955.19 of the Revised Code do not apply to risk retention groups. No risk retention group shall be required or permitted to join or contribute financially to the Ohio insurance guaranty association or similar mechanism in this state. No risk retention gro…

(A) A purchasing group and its insurer or insurers are subject to all applicable laws of this state, except that a purchasing group and its insurer or insurers, in regard to liability insurance for the purchasing group, are exempt from any law that does any of the following: (1) …

(A) No purchasing group shall conduct business in this state unless it has done both of the following: (1) Issued a notice to the superintendent of insurance that does all of the following: (a) Identifies the state in which the purchasing group is domiciled and all other states i…

(A) No purchasing group shall purchase insurance from a risk retention group that is not chartered, or from an insurer that is not admitted to do business, in the state in which the purchasing group is located, unless the purchase is effected through an agent or broker licensed i…

Premium taxes or taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any members of the purchasing group shall be imposed and paid in accordance with the following: (A) Imposed at the same rate and subject to the same interest, …

(A) The superintendent of insurance may exercise any powers to enforce the insurance laws of this state applicable to risk retention groups and purchasing groups, except those that are specifically preempted by the federal "Product Liability Risk Retention Act of 1981," 95 Stat. …

(A) No person shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance in this state from a risk retention group unless the person is licensed as an insurance agent or broker in accordance with Chapter 3905. of the Revised Code. (B) No person sh…

The superintendent of insurance may adopt any rules necessary or desirable for the enforcement of sections 3960.01 to 3960.13 of the Revised Code.

The superintendent of insurance, after notice and an opportunity for hearing under Chapter 119. of the Revised Code, may do all of the following: (A) Suspend, revoke, or refuse to renew the certificate of authority of a risk retention group that violates any provision of sections…

As used in sections 3961.01 to 3961.09 of the Revised Code: (A)(1) "Discount medical plan" means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, offers access to members to providers of medical services and the ri…

(A) A discount medical plan organization shall not offer to members, or advertise to prospective members, discounted medical services unless the services are offered pursuant to a provider agreement. A discount medical plan organization may enter into a provider agreement directl…

(A) Prior to a discount medical plan organization allowing a marketer to market, promote, sell, or distribute a discount medical plan, the organization shall enter into a written agreement with the marketer. This agreement shall prohibit the marketer from using or issuing any adv…

(A) A discount medical plan organization or marketer shall disclose all of the following information in writing in not less than twelve-point type on the first content page of any advertisements, marketing materials, or brochures made available to the public relating to a discoun…

A discount medical plan organization shall not do any of the following: (A) Except when otherwise permitted in sections 3961.01 to 3961.09 of the Revised Code, as a disclaimer of any relationship between discount medical plan benefits and insurance, or in a description of an insu…

(A) A discount medical plan organization shall permit members to cancel membership in a discount medical plan at any time. (B) If a member gives notice of cancellation within thirty days after the date the member receives the written document described in division (C) of section …

(A) The superintendent of insurance may examine or investigate the business and affairs of a discount medical plan organization as the superintendent deems appropriate to protect the interests of the residents of this state. (B) When examining or investigating a discount medical …

(A) No person shall fail to comply with sections 3961.01 to 3961.09 of the Revised Code. If the superintendent of insurance determines that any person has violated sections 3961.01 to 3961.07 of the Revised Code, the superintendent may take one or more of the following actions: (…

The superintendent of insurance may adopt rules in accordance with Chapter 119. of the Revised Code for purposes of implementing sections 3961.01 to 3961.08 of the Revised Code.