Terms Used In Ohio Code > Chapter 1751 - Health Insuring Corporation Law

• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Another: when used to designate the owner of property which is the subject of an offense, includes not only natural persons but also every other owner of property. See Ohio Code 1.02
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Basic health care services: means the following services when medically necessary:

  (a) Physician's services, except when such services are supplemental under division (B) of this section;

  (b) Inpatient hospital services;

  (c) Outpatient medical services;

  (d) Emergency health services;

  (e) Urgent care services;

  (f) Diagnostic laboratory services and diagnostic and therapeutic radiologic services;

  (g) Diagnostic and treatment services, other than prescription drug services, for biologically based mental illnesses;

  (h) Preventive health care services, including, but not limited to, voluntary family planning services, infertility services, periodic physical examinations, prenatal obstetrical care, and well-child care;

  (i) Routine patient care for patients enrolled in an eligible cancer clinical trial pursuant to section 3923. See Ohio Code 1751.01

• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Biologically based mental illnesses: means schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, and panic disorder, as these terms are defined in the most recent edition of the diagnostic and statistical manual of mental disorders published by the American psychiatric association. See Ohio Code 1751.01
• Bond: includes an undertaking. See Ohio Code 1.02
• Certified nurse-midwife: means an advanced practice registered nurse who holds a current, valid license issued under Chapter 4723 of the Revised Code and is designated as a certified nurse-midwife in accordance with section 4723. See Ohio Code 1.64
• Child: includes child by adoption. See Ohio Code 1.59
• Closed panel plan: means a health care plan that requires enrollees to use participating providers. See Ohio Code 1751.01
• Compensation: means remuneration for the provision of health care services, determined on other than a fee-for-service or discounted-fee-for-service basis. See Ohio Code 1751.01
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Continuance: Putting off of a hearing ot trial until a later time.
• Contract: A legal written agreement that becomes binding when signed.
• Contractual periodic prepayment: means the formula for determining the premium rate for all subscribers of a health insuring corporation. See Ohio Code 1751.01
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Corporation: means a corporation formed under Chapter 1701. See Ohio Code 1751.01
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Dependent: A person dependent for support upon another.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• Emergency health services: means those health care services that must be available on a seven-days-per-week, twenty-four-hours-per-day basis in order to prevent jeopardy to an enrollee's health status that would occur if such services were not received as soon as possible, and includes, where appropriate, provisions for transportation and indemnity payments or service agreements for out-of-area coverage. See Ohio Code 1751.01
• Enrollee: means any natural person who is entitled to receive health care benefits provided by a health insuring corporation. See Ohio Code 1751.01
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Evidence of coverage: means any certificate, agreement, policy, or contract issued to a subscriber that sets out the coverage and other rights to which such person is entitled under a health care plan. See Ohio Code 1751.01
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• Fiduciary: A trustee, executor, or administrator.
• Fraud: Intentional deception resulting in injury to another.
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health care facility: means any facility, except a health care practitioner's office, that provides preventive, diagnostic, therapeutic, acute convalescent, rehabilitation, mental health, intellectual disability, intermediate care, or skilled nursing services. See Ohio Code 1751.01
• Health care services: means basic, supplemental, and specialty health care services. See Ohio Code 1751.01
• Health delivery network: means any group of providers or health care facilities, or both, or any representative thereof, that have entered into an agreement to offer health care services in a panel rather than on an individual basis. See Ohio Code 1751.01
• Health insuring corporation: means a corporation, as defined in division (H) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan. See Ohio Code 1751.01
• in writing: includes any representation of words, letters, symbols, or figures; this provision does not affect any law relating to signatures. See Ohio Code 1.59
• Intermediary organization: means a health delivery network or other entity that contracts with licensed health insuring corporations or self-insured employers, or both, to provide health care services, and that enters into contractual arrangements with other entities for the provision of health care services for the purpose of fulfilling the terms of its contracts with the health insuring corporations and self-insured employers. See Ohio Code 1751.01
• Intermediate care: means residential care above the level of room and board for patients who require personal assistance and health-related services, but who do not require skilled nursing care. See Ohio Code 1751.01
• Internet: means the international computer network of both federal and nonfederal interoperable packet switched data networks, including the graphical subnetwork known as the world wide web. See Ohio Code 1.59
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Medical record: means the personal information that relates to an individual's physical or mental condition, medical history, or medical treatment. See Ohio Code 1751.01
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Open panel plan: means a health care plan that provides incentives for enrollees to use participating providers and that also allows enrollees to use providers that are not participating providers. See Ohio Code 1751.01
• Osteopathic hospital: means a hospital registered under section 3701. See Ohio Code 1751.01
• Oversight: Committee review of the activities of a Federal agency or program.
• Panel: means a group of providers or health care facilities that have joined together to deliver health care services through a contractual arrangement with a health insuring corporation, employer group, or other payor. See Ohio Code 1751.01
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: includes an individual, corporation, business trust, estate, trust, partnership, and association. See Ohio Code 1.59
• Population: means that shown by the most recent regular federal census. See Ohio Code 1.59
• Premium rate: means any set fee regularly paid by a subscriber to a health insuring corporation. See Ohio Code 1751.01
• Primary care provider: means a provider that is designated by a health insuring corporation to supervise, coordinate, or provide initial care or continuing care to an enrollee, and that may be required by the health insuring corporation to initiate a referral for specialty care and to maintain supervision of the health care services rendered to the enrollee. See Ohio Code 1751.01
• Property: means real and personal property. See Ohio Code 1.59
• Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
• Provider: means any natural person or partnership of natural persons who are licensed, certified, accredited, or otherwise authorized in this state to furnish health care services, or any professional association organized under Chapter 1785 of the Revised Code, provided that nothing in this chapter or other provisions of law shall be construed to preclude a health insuring corporation, health care practitioner, or organized health care group associated with a health insuring corporation from employing certified nurse practitioners, certified nurse anesthetists, clinical nurse specialists, certified nurse-midwives, pharmacists, dietitians, physician assistants, dental assistants, dental hygienists, optometric technicians, or other allied health personnel who are licensed, certified, accredited, or otherwise authorized in this state to furnish health care services. See Ohio Code 1751.01
• Provider sponsored organization: means a corporation, as defined in division (H) of this section, that is at least eighty per cent owned or controlled by one or more hospitals, as defined in section 3727. See Ohio Code 1751.01
• Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
• Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. ^{Source: FDIC}
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Rule: includes regulation. See Ohio Code 1.59
• Service of process: The service of writs or summonses to the appropriate party.
• Solicitation document: means the written materials provided to prospective subscribers or enrollees, or both, and used for advertising and marketing to induce enrollment in the health care plans of a health insuring corporation. See Ohio Code 1751.01
• Specialty health care services: means one of the supplemental health care services listed in division (B) of this section, when provided by a health insuring corporation on an outpatient-only basis and not in combination with other supplemental health care services. See Ohio Code 1751.01
• state: means the state of Ohio. See Ohio Code 1.59
• Statute: A law passed by a legislature.
• Subscriber: means a person who is responsible for making payments to a health insuring corporation for participation in a health care plan, or an enrollee whose employment or other status is the basis of eligibility for enrollment in a health insuring corporation. See Ohio Code 1751.01
• Supplemental health care services: means any health care services other than basic health care services that a health insuring corporation may offer, alone or in combination with either basic health care services or other supplemental health care services, and includes:

  (a) Services of facilities for intermediate or long-term care, or both;

  (b) Dental care services;

  (c) Vision care and optometric services including lenses and frames;

  (d) Podiatric care or foot care services;

  (e) Mental health services, excluding diagnostic and treatment services for biologically based mental illnesses;

  (f) Short-term outpatient evaluative and crisis-intervention mental health services;

  (g) Medical or psychological treatment and referral services for alcohol and drug abuse or addiction;

  (h) Home health services;

  (i) Prescription drug services;

  (j) Nursing services;

  (k) Services of a dietitian licensed under Chapter 4759 of the Revised Code;

  (l) Physical therapy services;

  (m) Chiropractic services;

  (n) Any other category of services approved by the superintendent of insurance. See Ohio Code 1751.01

• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Trustee: A person or institution holding and administering property in trust.
• United States: includes all the states. See Ohio Code 1.59
• Urgent care services: means those health care services that are appropriately provided for an unforeseen condition of a kind that usually requires medical attention without delay but that does not pose a threat to the life, limb, or permanent health of the injured or ill person, and may include such health care services provided out of the health insuring corporation's approved service area pursuant to indemnity payments or service agreements. See Ohio Code 1751.01
• Whoever: includes all persons, natural and artificial; partners; principals, agents, and employees; and all officials, public or private. See Ohio Code 1.02