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Ohio Statutes, Title 39

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Ohio/Statutes

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Title 39, Title 39. Insurance

43 chapters · 1,367 sections in this title.

All chapters in Title 391,367 Ch 3901, Chapter 3901 | Superintendent Of Ins…150 Ch 3905, Chapter 3905 | Insurance Producers L…123 Ch 3923, Chapter 3923 | Sickness And Accident…109 Ch 3903, Chapter 3903 | Reserve Valuation; Re…92 Ch 3929, Chapter 3929 | Domestic And Foreign …77 Ch 3941, Chapter 3941 | Operation Of Mutual I…51 Ch 3937, Chapter 3937 | Casualty Insurance; M…50 Ch 3921, Chapter 3921 | Fraternal Benefit Soc…43 Ch 3919, Chapter 3919 | Mutual Protective Ins…40 Ch 3925, Chapter 3925 | Domestic Insurance Co…36 Ch 3953, Chapter 3953 | Title Insurance36 Ch 3924, Chapter 3924 | Small Employer Health…33 Ch 3964, Chapter 3964 | Captive Insurance Com…33 Ch 3902, Chapter 3902 | Insurance Policies An…32

1,367 sections·Filtered byTitle 39✕

Ohio Rev. Code Ann. § 3901.25 Action by superintendent against insurer
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If after thirty days following the giving of the notice mentioned in section 3901.24 of the Revised Code such insurer has failed to cease making, issuing, or circulating such false misrepresentations or causing the same to be made, issued, or circulated in this state, and if the …
Ohio Rev. Code Ann. § 3901.26 Acts by insurer which constitute appointment of superintendent as attorney - service of statement
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(A) Any of the following acts in this state, effected by mail or otherwise, by any such unauthorized foreign or alien insurer; (1) the issuance or delivery of contracts or insurance to residents of this state, (2) the solicitation of applications for such contracts, (3) the colle…
Ohio Rev. Code Ann. § 3901.27 Adoption of emergency bylaws
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The board of directors of any domestic insurance company may at any time adopt emergency bylaws, subject to repeal or change by action of those having power to adopt regular bylaws for the company, which shall be operative during an emergency, and which may, notwithstanding any d…
Ohio Rev. Code Ann. § 3901.28 Provisions effective if no emergency bylaws
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In the event that the board of directors of a domestic insurance company has not adopted emergency bylaws, the following provisions shall become effective upon the occurrence of an emergency as described in section 3901.27 of the Revised Code.(A) Three directors shall constitute …

Ohio Rev. Code Ann. § 3901.29 Succession list

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At any time the board of directors of a domestic insurance company may, by resolution, provide that in the event of an emergency, as described in section 3901.27 of the Revised Code, and in the event of the death or incapacity of the president, the secretary, or the treasurer of …

Ohio Rev. Code Ann. § 3901.30 Emergency business location

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At any time, the board of directors of a domestic insurance company may, by resolution, provide that in the event of an emergency, as described in section 3901.27 of the Revised Code, the home office or principal place of business of the company shall be at such location as is na…

Ohio Rev. Code Ann. § 3901.31 Filing statements indicating ownership

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(A) Every person who is directly or indirectly the beneficial owner of more than ten per cent of any class of any equity security of a domestic stock insurance company which is not a wholly owned subsidiary of an insurance holding company system or who is a director or officer of…

Ohio Rev. Code Ann. § 3901.32 Insurance holding company system definitions

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As used in sections 3901.32 to 3901.37 of the Revised Code: (A) "Affiliate of" or "affiliated with" a specific person means a person that, directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with, the person specified…

Ohio Rev. Code Ann. § 3901.321 Mergers and acquisitions of domestic insurers

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(A) For the purposes of this section: (1) "Acquiring party" means any person by whom or on whose behalf a merger or other acquisition of control is to be effected. (2) "Domestic insurer" includes any person controlling a domestic insurer unless the person, as determined by the su…

Ohio Rev. Code Ann. § 3901.322 Procedure for violations

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(A) Whenever it appears to the superintendent of insurance that any person has committed or is about to commit a violation of section 3901.321 of the Revised Code or of any rule or order issued by the superintendent under that section, the superintendent may apply to the court of…

Ohio Rev. Code Ann. § 3901.323 Jurisdiction

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(A) The courts of this state have personal jurisdiction over both of the following:(1) Every person that is not a resident or domiciliary of, nor authorized to do business in, this state, and that files a statement with the superintendent of insurance under section 3901.321 of th…

Ohio Rev. Code Ann. § 3901.33 Registration; enterprise risk report; group capital calculation; liquidity stress test

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(A) Every insurer that is authorized to do business in this state and that is a member of an insurance holding company system shall register with the superintendent of insurance, except a foreign insurer subject to disclosure requirements and standards adopted by statute or regul…

Ohio Rev. Code Ann. § 3901.34 Transactions to which insurer is a party; dividends and distributions to shareholders

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(A) Transactions within an insurance holding company system to which an insurer subject to registration is a party shall be subject to the following standards: (1) The terms shall be fair and reasonable. (2) Charges or fees for services performed shall be reasonable. (3) Expenses…

Ohio Rev. Code Ann. § 3901.341 Prior review of proposed transactions

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(A) No insurer subject to registration under section 3901.33 of the Revised Code shall enter into any of the following transactions with any person in its insurance holding company system, including amendments or modifications of affiliate agreements previously filed under this s…

Ohio Rev. Code Ann. § 3901.35 Requiring production of records

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(A)(1) In addition to the powers that the superintendent has under sections 3901.01 to 3901.31 of the Revised Code, relating to the examination of insurers, the superintendent of insurance, subject to sections 119.01 to 119.13 of the Revised Code, shall also have the power to exa…

Ohio Rev. Code Ann. § 3901.351 Participation in supervisory college

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(A) With respect to any insurer registered under section 3901.33 of the Revised Code and in accordance with division (C) of this section, the superintendent of insurance may participate in a supervisory college for any domestic insurer that is part of an insurance holding company…

Ohio Rev. Code Ann. § 3901.352 Group-wide supervisor for internationally active insurance group

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(A)(1) The superintendent of insurance is authorized to act as the group-wide supervisor for any internationally active insurance group in accordance with this section. However, the superintendent may otherwise acknowledge a regulatory official from another jurisdiction as the gr…

Ohio Rev. Code Ann. § 3901.36 Confidential and privileged treatment of documents and information - exceptions

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(A)(1) Documents, materials, or other information in the possession or control of the department of insurance that are obtained by or disclosed to the superintendent of insurance or any other person in the course of an examination or investigation made pursuant to section 3901.35…

Ohio Rev. Code Ann. § 3901.37 Suspension, revocation or refusal to renew license - civil forfeiture

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(A) Whenever it appears to the superintendent of insurance that any person has committed a violation of section 3901.33, 3901.34, 3901.341, or 3901.35 of the Revised Code, which makes the continued operation of an insurer contrary to the interests of policyholders or the public, …

Ohio Rev. Code Ann. § 3901.371 Purpose of sections 3901.371 to 3901.378

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The purpose of sections 3901.371 to 3901.378 of the Revised Code is to provide the requirements for maintaining a risk management framework and completing an own risk and solvency assessment, and to provide guidance and instructions for filing an own risk and solvency assessment …

Ohio Rev. Code Ann. § 3901.372 Definitions

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For the purposes of sections 3901.371 to 3907.378 of the Revised Code: (A) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in section 3901.32 of the Revised Code.(B) "Insurer" has the same meaning as set forth i…

Ohio Rev. Code Ann. § 3901.373 Risk management framework

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An insurer shall maintain a risk management framework to assist the insurer with identifying, assessing, monitoring, managing, and reporting on its material and relevant risks. This requirement may be satisfied if the insurance group of which the insurer is a member maintains a r…

Ohio Rev. Code Ann. § 3901.374 Own risk and solvency assessment

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Unless exempted by section 3901.376 of the Revised Code, an insurer, or the insurance group of which the insurer is a member, shall regularly conduct an own risk and solvency assessment consistent with a process comparable to the own risk and solvency assessment guidance manual. …

Ohio Rev. Code Ann. § 3901.375 Summary report

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(A)(1) Upon the request of the superintendent of insurance, and not more than once annually, an insurer shall submit to the superintendent an own risk and solvency assessment summary report, or any combination of reports that together contain the information described in the own …

Ohio Rev. Code Ann. § 3901.376 Exemptions

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(A)(1) An insurer shall be exempt from the requirements of sections 3901.371 to 3901.378 of the Revised Code if both of the following apply: (a) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium, less than f…

Ohio Rev. Code Ann. § 3901.377 Form and content of report; review

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(A) The own risk and solvency assessment summary report shall be prepared consistent with the own risk and solvency assessment guidance manual, subject to the requirements of division (B) of this section, and all documentation and supporting information shall be maintained and ma…

Ohio Rev. Code Ann. § 3901.378 Confidentiality

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(A) Documents, materials, or other information, including the own risk and solvency assessment summary report, in the possession or control of the department of insurance that are obtained by, created by, or disclosed to the superintendent of insurance, or any other person under …

Ohio Rev. Code Ann. § 3901.38 Prompt payments to health care providers definitions

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As used in this section and sections 3901.381 to 3901.3814 of the Revised Code:(A) "Beneficiary" means any policyholder, subscriber, member, employee, or other person who is eligible for benefits under a benefits contract.(B) "Benefits contract" means a sickness and accident insu…

Ohio Rev. Code Ann. § 3901.381 Third-party payers processing claims for payment for health care services

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(A) Except as provided in sections 3901.382, 3901.383, 3901.384, and 3901.386 of the Revised Code, a third-party payer shall process a claim for payment for health care services rendered by a provider to a beneficiary in accordance with this section. (B)(1) Unless division (B)(2)…

Ohio Rev. Code Ann. § 3901.3810 Complaints by provider or beneficiary - retaliation by payer

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(A) A provider or beneficiary aggrieved with respect to any act of a third-party payer that the provider or beneficiary believes to be a violation of sections 3901.381 to 3901.388 of the Revised Code may file a written complaint with the superintendent of insurance regarding the …

Ohio Rev. Code Ann. § 3901.3811 Failure to comply by third-party payer

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(A) No third-party payer shall fail to comply with sections 3901.381 and 3901.384 to 3901.3810 of the Revised Code.(B) The superintendent of insurance may require third-party payers to submit reports of their compliance with division (A) of this section. If reports are required, …

Ohio Rev. Code Ann. § 3901.3812 Administrative remedies

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(A) If, after completion of an examination involving information collected from a six-month period, the superintendent finds that a third-party payer has committed a series of violations that, taken together, constitutes a consistent pattern or practice of violating division (A) …

Ohio Rev. Code Ann. § 3901.3813 Rules

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The superintendent of insurance may adopt rules as the superintendent considers necessary to carry out the purposes of section 3901.38 and sections 3901.381 to 3901.3812 of the Revised Code. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.

Ohio Rev. Code Ann. § 3901.3814 Exceptions to provisions

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Sections 3901.38 and 3901.381 to 3901.3813 of the Revised Code do not apply to the following: (A) Policies offering coverage that is regulated under Chapters 3935. and 3937. of the Revised Code; (B) An employer's self-insurance plan and any of its administrators, as defined in se…

Ohio Rev. Code Ann. § 3901.3815 Health plan issuer payment method and disclosure requirements

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(A) As used in this section: (1) "Health plan issuer" has the same meaning as in section 3922.01 of the Revised Code, except that the term also includes any vendor contracted by a health plan issuer, as defined in that section. (2) "Health care provider" has the same meaning as i…

Ohio Rev. Code Ann. § 3901.382 Electronic submission of claims

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Beginning six months after the date specified in section 262 of the "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 2027, 42 U.S.C.A. 1320d-4, on which a third-party payer is initially required to comply with a standard or implementation specification for…

Ohio Rev. Code Ann. § 3901.383 Contractual agreements for payments by third-party payers

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(A) A provider and a third-party payer may do either of the following:(1) Enter into a contractual agreement under which time periods shorter than those set forth in section 3901.381 of the Revised Code are applicable to the third-party payer in paying a claim for any amount due …

Ohio Rev. Code Ann. § 3901.384 Untimely claim process

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(A) Subject to division (B) of this section, a third-party payer that requires timely submission of claims for payment for health care services shall process a claim that is not submitted in a timely manner if a claim for the same services was initially submitted to a different t…

Ohio Rev. Code Ann. § 3901.385 Third-party payer - prohibited acts

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A third-party payer shall not do either of the following:(A) Engage in any business practice that unfairly or unnecessarily delays the processing of a claim or the payment of any amount due for health care services rendered by a provider to a beneficiary;(B) Refuse to process or …

Ohio Rev. Code Ann. § 3901.386 Reimbursement contract - reimbursements to be made directly to hospital - assignment of benefits

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(A) Notwithstanding section 1751.13 or division (I)(2) of section 3923.04 of the Revised Code, a reimbursement contract entered into or renewed on or after June 29, 1988, between a third-party payer and a hospital shall provide that reimbursement for any service provided by a hos…

Ohio Rev. Code Ann. § 3901.387 Duplicative claims - claim information system

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(A) When a provider or beneficiary submits a duplicative claim for payment for health care services before the time periods specified in section 3901.381 of the Revised Code have elapsed for the original claim submitted, the third-party payer may deny the duplicative claim. Denia…

Ohio Rev. Code Ann. § 3901.388 Payments considered final - overpayment

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(A) A payment made by a third-party payer to a provider in accordance with sections 3901.381 to 3901.386 of the Revised Code shall be considered final two years after payment is made. After that date, the amount of the payment is not subject to adjustment, except in the case of f…

Ohio Rev. Code Ann. § 3901.389 Computation of interest

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(A) Any third-party payer that fails to comply with section 3901.381 of the Revised Code, or any contractual payment arrangement entered into under section 3901.383 of the Revised Code, shall pay interest in accordance with this section.(B) Interest shall be computed based upon t…

Ohio Rev. Code Ann. § 3901.40 Payment or reimbursement to unlicensed or unaccredited hospital prohibited

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No insurance company, health insuring corporation, or self-insurance plan authorized to do business in this state shall include or provide in its policies or subscriber agreements for benefit payments or reimbursement for services in any hospital which is not licensed under Chapt…

Ohio Rev. Code Ann. § 3901.41 Applicability of Uniform Electronics Transactions Act; automated transactions

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(A) As used in this section: (1) "Automated transaction" has the same meaning as in section 1306.01 of the Revised Code, and includes electronic transactions between two or more persons conducting business pursuant to the laws of this state relating to insurance. (2) "Contact poi…

Ohio Rev. Code Ann. § 3901.411 Electronic delivery of insurance documents

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(A) As used in this section: (1) "Health benefit plan" means a policy, contract, certificate, or agreement entered into, offered, or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a vision or dental…

Ohio Rev. Code Ann. § 3901.42 Annual filing with national association of insurance commissioners

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(A) As used in this section, "actuarial certification" means certification by a member in good standing of the American academy of actuaries, or a person who otherwise has competency in loss reserve valuation.(B) Each domestic, foreign, and alien insurer authorized to transact in…

Ohio Rev. Code Ann. § 3901.44 Records of insurance fraud investigation

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(A) As used in this section, "insurance fraud investigation" means any investigation conducted by the superintendent of insurance or a designee of the superintendent that relates to a fraudulent insurance act as defined in section 3999.31 of the Revised Code.(B) All documents, re…

Ohio Rev. Code Ann. § 3901.45 Effect of sexual orientation, HIV, or AIDS or related condition

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(A) As used in sections 3901.45 and 3901.46 of the Revised Code: (1) "AIDS," "HIV," "AIDS-related condition," and "HIV test" have the same meanings as in section 3701.24 of the Revised Code. (2) "Insurer" means any person authorized to engage in the business of life or sickness a…

Ohio Rev. Code Ann. § 3901.46 Requiring HIV testing

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As used in this section, "membership organization" means a fraternal or other association or group of individuals involved in the same occupation, activity, or interest that is organized and maintained in good faith for purposes other than to obtain insurance and is not organized…