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Ohio Statutes, Title 39

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Ohio/Statutes

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Title 39, Insurance

44 chapters · 1,388 sections in this title.

All chapters in Title 391,388 Ch 3901, Superintendent Of Insurance151 Ch 3905, Insurance Producers Licensing Act123 Ch 3923, Sickness And Accident Insurance109 Ch 3903, Reserve Valuation; Rehabilitation An…92 Ch 3929, Domestic And Foreign Insurance Compa…77 Ch 3941, Operation Of Mutual Insurance Companies51 Ch 3937, Casualty Insurance; Motor Vehicle In…50 Ch 3921, Fraternal Benefit Societies43 Ch 3919, Mutual Protective Insurance Upon Persons40 Ch 3925, Domestic Insurance Companies Other T…36 Ch 3953, Title Insurance36 Ch 3924, Small Employer Health Benefit Plans;…33 Ch 3964, Captive Insurance Companies33 Ch 3902, Insurance Policies And Contracts32

1,388 sections·Filtered byTitle 39✕

Ohio Rev. Code Ann. § 3922.15 Qualifications for clinical reviewers
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All clinical reviewers assigned by an independent review organization to conduct external reviews shall have the same license as the health care provider of the service in question, and shall be physicians or other appropriate health care providers who meet all of the following m…
Ohio Rev. Code Ann. § 3922.16 Construction of chapter; limitations on liability
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(A) Nothing in this chapter shall be construed to create a cause of action against any of the following: (1) An employer that provides health care benefits to employees through a health plan issuer; (2) A clinical reviewer or independent review organization that participates in a…
Ohio Rev. Code Ann. § 3922.17 Maintenance of records; reports
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(A)(1) An independent review organization assigned pursuant to sections 3922.08, 3922.09, or 3922.10 of the Revised Code to conduct an external review shall maintain written records in accordance with the associated rules established by the superintendent, in the aggregate by sta…
Ohio Rev. Code Ann. § 3922.18 Payment of costs

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The health plan issuer against which a request for a standard external review or an expedited external review is filed shall pay the cost of the external review, including the cost of any external review that is required at the direction of the superintendent. If the superintende…

Ohio Rev. Code Ann. § 3922.19 Disclosure of external review procedures

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(A) Each health plan issuer shall include a description of its external review procedures, including the superintendent's contractual review, in, or attached to, the policy, certificate, membership booklet, or outline of coverage, or other evidence of coverage it provides to cove…

Ohio Rev. Code Ann. § 3922.20 Admissibility of written decision or medicare reimbursement standards

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Consistent with the Rules of Evidence, a written decision or opinion prepared by an independent review organization under this chapter shall be admissible in any civil action related to the coverage decision that was the subject of the decision or opinion. The independent review …

Ohio Rev. Code Ann. § 3922.21 Confidentiality

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(A) When a record containing information pertaining to the medical history, diagnosis, prognosis, or medical condition of a covered person is provided to the superintendent of insurance for any reason under this chapter or sections 1751.77 to 1751.87 of the Revised Code, regardle…

Ohio Rev. Code Ann. § 3922.22 Adoption of rules

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The superintendent may adopt rules under Chapter 119. of the Revised Code to carry out the purposes of this chapter and shall prescribe forms relating to notices, appeals, and requests for external review under this chapter.

Ohio Rev. Code Ann. § 3922.23 Violation; Penalties

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A violation of this chapter shall be an unfair or deceptive act or practice under sections 3901.19 to 3901.26 of the Revised Code. Additionally, health plan issuers holding a certificate of authority from the superintendent are also subject to the following: (A) If, after notice …

Ohio Rev. Code Ann. § 3923.01 Policy of sickness and accident insurance defined

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As used in this chapter, "policy of sickness and accident insurance" includes any policy, contract, or certificate of insurance against loss or expense resulting from the sickness of the insured, or from the bodily injury or death of the insured by accident, or both, that is deli…

Ohio Rev. Code Ann. § 3923.011 Sickness and accident insurance definitions

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As used in any policy of sickness and accident insurance delivered, issued for delivery, or used in this state, unless otherwise provided in the policy or in an indorsement thereon or in a rider attached thereto: (A) "Total disability" means inability to perform the duties of any…

Ohio Rev. Code Ann. § 3923.02 Form of policy filed with superintendent

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No certificate shall be furnished by any insurer in connection with, or pursuant to any provision of, any group sickness and accident insurance policy delivered, issued for delivery, or used in this state, and no policy of sickness and accident insurance shall be delivered, issue…

Ohio Rev. Code Ann. § 3923.021 Approval or disapproval of premium rates

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(A) As used in this section: (1) "Benefits provided are not unreasonable in relation to the premium charged" means the rates were calculated in accordance with sound actuarial principles. (2) "Individual policy of sickness and accident insurance" includes sickness and accident in…

Ohio Rev. Code Ann. § 3923.022 Maximum aggregate administrative expenses

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(A) As used in this section: (1)(a) "Administrative expense" means the amount resulting from the following: the amount of premiums earned by the insurer for sickness and accident insurance business plus the amount of losses recovered from reinsurance coverage minus the sum of the…

Ohio Rev. Code Ann. § 3923.03 Necessary provisions

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No policy of sickness and accident insurance shall be delivered, issued for delivery, or used in this state unless all the following requirements are complied with: (A) The entire money and other considerations therefor are expressed therein. (B) The time at which insurance takes…

Ohio Rev. Code Ann. § 3923.04 Policy standard provisions

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Except as provided in section 3923.07 of the Revised Code, every policy of sickness and accident insurance delivered, issued for delivery, or used in this state shall contain the standard provisions specified in this section in the words in which the same appear in this section. …

Ohio Rev. Code Ann. § 3923.041 Policies with prior authorization requirement provisions

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(A) As used in this section: (1) "Chronic condition" means a medical condition that has persisted after reasonable efforts have been made to relieve or cure its cause and has continued, either continuously or episodically, for longer than six continuous months. (2) "Clinical peer…

Ohio Rev. Code Ann. § 3923.05 Provisions to conform to prescribed wording

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Except as provided in section 3923.07 of the Revised Code, no policy of sickness and accident insurance delivered, issued for delivery, or used in this state shall contain provisions respecting the matters set forth in this section unless such provisions are in the words in which…

Ohio Rev. Code Ann. § 3923.06 Order of presentation of policy provisions

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The policy provisions set forth in sections 3923.04 and 3923.05 of the Revised Code or any corresponding policy provisions used in lieu thereof in accordance with section 3923.07 of the Revised Code shall be printed in each policy of sickness and accident insurance in the order i…

Ohio Rev. Code Ann. § 3923.061 Interest on proceeds payable due to death by sickness or accident

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(A) On and after January 1, 2003, any insurance company authorized to do business in this state shall pay interest, in accordance with division (B) of this section and subject to division (C) of this section, on any proceeds that become due pursuant to the terms of a policy of si…

Ohio Rev. Code Ann. § 3923.07 Omission or substitution of provisions

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If any policy provision set forth in section 3923.04 or 3923.05 of the Revised Code is in whole or in part inapplicable or inconsistent with the coverage provided by a policy of sickness and accident insurance, the insurer shall, with the approval of the superintendent of insuran…

Ohio Rev. Code Ann. § 3923.071 Policies, applications, riders or indorsements issued prior to 10-1-53

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Any policy of sickness and accident insurance, indorsement, rider, or application which could have been lawfully delivered, issued for delivery, or used in this state on October 1, 1953, may be delivered, issued for delivery, or used in this state until January 1, 1956, without b…

Ohio Rev. Code Ann. § 3923.08 Nonconflicting provisions permitted in policy

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Any foreign or alien insurer authorized to do business in this state may, with the approval of the superintendent of insurance, insert in any policy of sickness and accident insurance, delivered, issued for delivery, or used in this state, any provision required by the laws of th…

Ohio Rev. Code Ann. § 3923.09 Validity of nonconforming policy

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A policy of sickness and accident insurance issued in violation of sections 3923.01 to 3923.22, inclusive, of the Revised Code, is valid but shall be construed as provided by such sections, and when any provision in such policy is in conflict with such sections, the rights, dutie…

Ohio Rev. Code Ann. § 3923.10 Industrial sickness and accident insurance

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Industrial sickness and accident insurance is that form of sickness and accident insurance under individual policies for which the premium is payable weekly, and includes any such policy which covers sickness only or accident only. Any insurer authorized to make, transact, or iss…

Ohio Rev. Code Ann. § 3923.11 Sickness and accident insurance on a franchise plan

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(A) Sickness and accident insurance on a franchise plan is that form of sickness and accident insurance issued to either of the following: (1) Five or more or, with respect to long-term care or disability income insurance, two or more employees of any corporation, copartnership, …

Ohio Rev. Code Ann. § 3923.12 Group sickness and accident insurance

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(A) Group sickness and accident insurance is that form of sickness and accident insurance covering any group of two or more employees, members, or other persons, with or without one or more of their dependents and members of their immediate families. Such insurance may be offered…

Ohio Rev. Code Ann. § 3923.121 Association of insurers to provide basic medical coverage to persons 65 or older

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(A) As used in this section: (1) "Association" means a voluntary unincorporated association of insurers formed for the sole purpose of enabling cooperative action to provide sickness and accident insurance in accordance with this section. (2) "Insurer" means any insurance company…

Ohio Rev. Code Ann. § 3923.123 Association of insurers to provide group health coverage to qualified unemployed persons

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(A) As used in this section: (1) "Association" means a voluntary unincorporated association of insurers formed for the sole purpose of enabling cooperative action to provide health coverage in accordance with this section. (2) "Insurer" includes any insurance company authorized t…

Ohio Rev. Code Ann. § 3923.13 Blanket sickness and accident insurance

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Blanket sickness and accident insurance is that form of sickness and accident insurance covering special groups of persons as enumerated in one of the following divisions: (A) Under a policy issued to any common carrier, which shall be deemed the policyholder, covering a group de…

Ohio Rev. Code Ann. § 3923.14 False statement in application - alteration of written application

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The falsity of any statement in the application for any policy of sickness and accident insurance shall not bar the right to recovery thereunder, or be used in evidence at any trial to recover upon such policy, unless it is clearly proved that such false statement is willfully fa…

Ohio Rev. Code Ann. § 3923.141 Agent of the insurer

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Any person who solicits an application for, or for reinstatement of, a policy of sickness and accident insurance to insure any other person shall be considered the agent of the insurer and not of the insured in any controversy between the insured or his beneficiary and the insure…

Ohio Rev. Code Ann. § 3923.15 Unfair discrimination prohibited

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No insurer doing the business of sickness and accident insurance in this state shall make or permit any unfair discrimination between individuals of substantially the same hazard in the amount of premium rates charged for any policy or contract of such insurance or in the benefit…

Ohio Rev. Code Ann. § 3923.16 Misleading or deceptive advertising prohibited

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No insurer doing business in this state, and no insurance agent, solicitor, or broker, shall use in connection with the solicitation of sickness and accident insurance any advertising copy, advertising practice, or plan of solicitation which is materially misleading or deceptive.…

Ohio Rev. Code Ann. § 3923.161 Describing cancellability and renewability provisions clearly and with prominence or emphasis

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(A) No insurer doing business in this state, and no insurance agent, solicitor, or broker, shall, in connection with any advertising copy, advertising practice, or plan of solicitation, refer to noncancellation provisions of a sickness and accident insurance policy without succes…

Ohio Rev. Code Ann. § 3923.17 Prohibition of rebates not to prohibit commissions or dividends

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The laws of this state prohibiting rebates do not prohibit any of the following: (A) The payment of a commission or other compensation to any licensed agent or broker; (B) Any insurer from allowing or returning to its participating policyholders dividends, savings, or unused prem…

Ohio Rev. Code Ann. § 3923.18 Rights of insurer in defense of claim not waived

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The acknowledgment by an insurer of the receipt of notice given under any policy of sickness and accident insurance, or the furnishing by him of forms for filing proofs of loss, or his acceptance of such proofs, or his investigation of any claim thereunder, shall not operate as a…

Ohio Rev. Code Ann. § 3923.19 Benefits exempt from legal process - exception

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(A) Benefits under all policies of sickness and accident insurance are not liable to attachment or other process, or to be taken, appropriated, or applied by any legal or equitable process or by operation of law, either before or after payment of the benefits, to pay any liabilit…

Ohio Rev. Code Ann. § 3923.20 Exemptions for certain insurance policies

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Sections 3923.01 to 3923.22, inclusive, of the Revised Code, do not apply to or affect: (A)(1) Any policy of liability insurance, with or without supplementary expense coverage therein; (2) Any policy of motor vehicle liability insurance with supplementary coverage protecting the…

Ohio Rev. Code Ann. § 3923.21 Prohibition against delivery of policy on disapproved insurance form

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If, after notice and hearing, the superintendent of insurance finds that any insurer, insurance agent, solicitor, or broker has delivered or issued for delivery or use in this state any policy of sickness and accident insurance on a form which has been disapproved by the superint…

Ohio Rev. Code Ann. § 3923.22 Appeal - applicability of administrative procedure sections

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Any person, partnership, or corporation adversely affected by an order, finding, or determination of the superintendent of insurance may appeal to the court of common pleas of Franklin county in accordance with sections 119.01 to 119.13, inclusive, of the Revised Code. Said secti…

Ohio Rev. Code Ann. § 3923.23 Reimbursement for services of licensed osteopath, optometrist, chiropractor or podiatrist

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Notwithstanding any provision of any certificate furnished by an insurer in connection with, or pursuant to any group sickness and accident insurance policy delivered, issued for delivery, renewed or used, in or outside this state, on or after the effective date of this amendment…

Ohio Rev. Code Ann. § 3923.231 Reimbursement for services of licensed psychologist

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Notwithstanding any provision of any certificate furnished by an insurer in connection with, or pursuant to any group sickness and accident insurance policy delivered, issued, renewed or used, in or outside this state, on or after the effective date of this amendment, July 1, 198…

Ohio Rev. Code Ann. § 3923.232 Reimbursement for services of licensed dentist

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Notwithstanding any provision of any certificate furnished by an insurer in connection with, or pursuant to any group sickness and accident insurance policy delivered, issued, renewed or used, in or outside this state, on or after the effective date of this amendment, July 1, 198…

Ohio Rev. Code Ann. § 3923.233 Reimbursement for services of certified nurse-midwife performing service in collaboration with licensed physician

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Notwithstanding any provision of any certificate furnished by an insurer in connection with or pursuant to any group sickness and accident insurance policy delivered, issued, renewed, or used, in or outside this state, on or after January 1, 1985, and notwithstanding any provisio…

Ohio Rev. Code Ann. § 3923.234 Reimbursement for services of certified mechanotherapist

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Notwithstanding any provision of any certificate furnished by an insurer in connection with, or pursuant to any group sickness and accident insurance policy delivered, issued, renewed, or used, in or outside this state, on or after July 20, 1988, and notwithstanding any provision…

Ohio Rev. Code Ann. § 3923.24 Continuing coverage for dependent children

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(A) Notwithstanding section 3901.71 of the Revised Code, every certificate furnished by an insurer in connection with, or pursuant to any provision of, any group sickness and accident insurance policy delivered, issued for delivery, renewed, or used in this state on or after Janu…

Ohio Rev. Code Ann. § 3923.241 Public employee benefit plans - continuing coverage for dependent children

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(A) Notwithstanding section 3901.71 of the Revised Code, any public employee benefit plan that provides that coverage of an unmarried dependent child will terminate upon attainment of the limiting age for dependent children specified in the plan shall also provide in substance bo…

Ohio Rev. Code Ann. § 3923.25 Kidney dialysis benefits

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Every certificate furnished by an insurer in connection with, or pursuant to any provision of any group sickness and accident insurance policy delivered, issued for delivery, renewed, or used in this state, provided such policy was delivered, issued for delivery, or renewed on or…

Ohio Rev. Code Ann. § 3923.26 Coverage for newly born children from the moment of birth

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Every group policy or certificate of sickness and accident insurance delivered, issued for delivery, or renewed in this state providing coverage on an expense-incurred basis, and every individual policy of sickness and accident insurance delivered, issued for delivery, or renewed…