§ 3923.01 Policy of sickness and accident insurance defined
§ 3923.011 Sickness and accident insurance definitions
§ 3923.02 Form of policy filed with superintendent
§ 3923.021 Approval or disapproval of premium rates
§ 3923.022 Maximum aggregate administrative expenses
§ 3923.03 Necessary provisions
§ 3923.04 Policy standard provisions
§ 3923.041 Policies with prior authorization requirement provisions
§ 3923.05 Provisions to conform to prescribed wording
§ 3923.06 Order of presentation of policy provisions
§ 3923.061 Interest on proceeds payable due to death by sickness or accident
§ 3923.07 Omission or substitution of provisions
§ 3923.071 Policies, applications, riders or indorsements issued prior to 10-1-53
§ 3923.08 Nonconflicting provisions permitted in policy
§ 3923.09 Validity of nonconforming policy
§ 3923.10 Industrial sickness and accident insurance
§ 3923.11 Sickness and accident insurance on a franchise plan
§ 3923.12 Group sickness and accident insurance
§ 3923.121 Association of insurers to provide basic medical coverage to persons 65 or older
§ 3923.122 [Suspended eff. 1/1/2014 to 1/1/2026, per Section 3 of S.B. 9 of the 130th General Assembly, as amended] Option for conversion from group policy to individual policy
§ 3923.123 Association of insurers to provide group health coverage to qualified unemployed persons
§ 3923.13 Blanket sickness and accident insurance
§ 3923.14 False statement in application – alteration of written application
§ 3923.141 Agent of the insurer
§ 3923.15 Unfair discrimination prohibited
§ 3923.16 Misleading or deceptive advertising prohibited
§ 3923.161 Describing cancellability and renewability provisions clearly and with prominence or emphasis
§ 3923.17 Prohibition of rebates not to prohibit commissions or dividends
§ 3923.18 Rights of insurer in defense of claim not waived
§ 3923.19 Benefits exempt from legal process – exception
§ 3923.20 Exemptions for certain insurance policies
§ 3923.21 Prohibition against delivery of policy on disapproved insurance form
§ 3923.22 Appeal – applicability of administrative procedure sections
§ 3923.23 Reimbursement for services of licensed osteopath, optometrist, chiropractor or podiatrist
§ 3923.231 Reimbursement for services of licensed psychologist
§ 3923.232 Reimbursement for services of licensed dentist
§ 3923.233 Reimbursement for services of certified nurse-midwife performing service in collaboration with licensed physician
§ 3923.234 Reimbursement for services of certified mechanotherapist
§ 3923.24 Continuing coverage for dependent children
§ 3923.241 Public employee benefit plans – continuing coverage for dependent children
§ 3923.25 Kidney dialysis benefits
§ 3923.26 Coverage for newly born children from the moment of birth
§ 3923.27 Hospitalization coverage for mental illness
§ 3923.28 Outpatient coverage for mental or emotional disorders
§ 3923.281 Sickness and accident policies – biologically based mental illness
§ 3923.282 Health coverage plans – biologically based mental illness
§ 3923.29 Outpatient, inpatient, and intermediate primary care benefits for alcoholism
§ 3923.30 Requiring provision of coverage of treatment of mental or nervous disorders and alcoholism
§ 3923.301 Requiring provision of coverage for services of certified nurse-midwife performing service in collaboration with licensed physician
§ 3923.31 Right to rescind individual policy of sickness and accident insurance
§ 3923.32 Right of family member to continue coverage after subscriber’s death or upon change in marital relation to subscriber
§ 3923.33 Medicare supplement policy definitions
§ 3923.331 Statutes applicable to medicare supplement policies
§ 3923.332 Standards for policy provisions of medicare supplement policies and certificates
§ 3923.333 Benefits to be reasonable in relation to premium charged
§ 3923.334 Outline of coverage delivered at time application is made
§ 3923.335 Right to return policy or certificate and have premium refunded
§ 3923.336 Review and approval of advertisement by superintendent
§ 3923.337 Rules
§ 3923.338 Orders of superintendent
§ 3923.339 Severability
§ 3923.36 Excluding coverage of illness or injury covered by workers’ compensation
§ 3923.37 Prohibiting exclusion or reduction of benefits because of benefits payable under supplemental policy
§ 3923.38 Continuing policy upon termination of employment
§ 3923.381 Continuing coverage under group policy when reservist is called or ordered to active duty
§ 3923.382 Continuing coverage under group plan when reservist is called or ordered to active duty
§ 3923.39 Consolidated corporation cancelling individual policy for nonpayment
§ 3923.40 Coverage of adopted children
§ 3923.41 Long-term care insurance definitions
§ 3923.42 Citing provisions – applicability
§ 3923.43 Evidence to be filed by long-term care insurance association
§ 3923.44 Standards for full and fair disclosure for sale of long-term care insurance policies
§ 3923.441 Rescission of long-term care policy for misrepresentation
§ 3923.442 Offer of nonforfeiture benefit option with long-term care policy
§ 3923.443 Training required for agents selling long-term care policies
§ 3923.444 Compensation of agents selling long-term care policies
§ 3923.45 Forms
§ 3923.46 Rates for individual policy
§ 3923.47 Rules
§ 3923.48 Violation is unfair and deceptive insurance practice
§ 3923.49 Establishing outreach program to educate consumers
§ 3923.50 Notifying department of job and family services of long-term care insurance policies that comply with insurance department requirements
§ 3923.51 Group contracts of sickness and accident insurance persons under nineteen who are members of impoverished families
§ 3923.52 Screening mammography and cytologic screening benefits
§ 3923.53 Public employee benefit plan – breast cancer and cervical cancer screening
§ 3923.54 Employee health care benefit plan
§ 3923.55 Policy to include benefits for child health supervision services from moment of birth until age nine
§ 3923.56 Plan to include benefits for child health supervision services from moment of birth until age nine
§ 3923.57 Pre-existing conditions provisions
§ 3923.571 Conditions applying to group policies of sickness and accident insurance sold in connection with employment-related group health plan
§ 3923.58 [Suspended eff. 1/1/2014 to 1/1/2026, per Section 3 of S.B. 9 of the 130th General Assembly, as amended] Open enrollment coverage – insurers in the business of issuing individual policies of sickness and accident insurance
§ 3923.581 [Suspended eff. 1/1/2014 to 1/1/2026, per Section 3 of S.B. 9 of the 130th General Assembly, as amended] Open enrollment coverage – carriers in the business of issuing health benefit plans to individuals or nonemployer groups
§ 3923.582 [Suspended eff. 1/1/2014 to 1/1/2026, per Section 3 of S.B. 9 of the 130th General Assembly, as amended] Open enrollment coverage – responsibilities of superintendent of insurance
§ 3923.59 [Suspended eff. 1/1/2014 to 1/1/2026, per Section 3 of S.B. 9 of the 130th General Assembly, as amended] Open enrollment reinsurance program
§ 3923.60 Standard medical reference compendia for coverage of prescription drugs
§ 3923.601 Standardized prescription identification information – pharmacy benefits to be included
§ 3923.602 Medication synchronization for insured
§ 3923.61 Public employee benefit plans – prescription drugs
§ 3923.62 Disclosing determination of usual and customary fee for dental benefits
§ 3923.63 Coverage of inpatient care and follow-up care for mother and her newborn
§ 3923.64 Public employee benefit plans – maternity benefits
§ 3923.65 Coverage for emergency services
§ 3923.80 Denial of coverage to cancer clinical trial participant
§ 3923.81 Covered person’s payments not to exceed insurer payments
§ 3923.82 Coverage for alcohol or drug related losses or expenses
§ 3923.83 Standardized prescription identification information – pharmacy benefits to be included – public employee benefit plan
§ 3923.84 Coverage for autism spectrum disorder
§ 3923.85 Cancer medication; coverage for orally and intravenously administered treatments
§ 3923.851 Prior authorization requirements or other utilization review measures as conditions of providing coverage of an opioid analgesic prescribed for treatment of chronic pain; exceptions
§ 3923.86 Statement provided to insureds under vision policy
§ 3923.87 Compliance with section 3959.20
§ 3923.89 Payment or reimbursement to pharmacist
§ 3923.90 Teledentistry to be included in coverage
§ 3923.99 Penalty
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Terms Used In Ohio Code > Chapter 3923 - Sickness and Accident Insurance

  • 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.
  • Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
  • 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.
  • Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
  • 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
  • Certified nurse practitioner: 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 practitioner in accordance with section 4723. See Ohio Code 1.64
  • 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
  • Clinical nurse specialist: 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 clinical nurse specialist in accordance with section 4723. See Ohio Code 1.64
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • 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.
  • Dependent: A person dependent for support upon another.
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • 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.
  • Fraud: Intentional deception resulting in injury to another.
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • 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.
  • 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
  • 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.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • 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.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • 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
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • 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.
  • Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
  • Right of rescission: Right to cancel, within three business days, a contract that uses the home of a person as collateral, except in the case of a first mortgage loan. There is no fee to the borrower, who receives a full refund of all fees paid. The right of rescission is guaranteed by the Truth in Lending Act (TILA). Source: OCC
  • Rule: includes regulation. See Ohio Code 1.59
  • Service of process: The service of writs or summonses to the appropriate party.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • state: means the state of Ohio. See Ohio Code 1.59
  • Statute: A law passed by a legislature.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • United States: includes all the states. See Ohio Code 1.59
  • Whoever: includes all persons, natural and artificial; partners; principals, agents, and employees; and all officials, public or private. See Ohio Code 1.02