Ohio § 3902.50 Definitions for R.C. 3902.50 to 3902.72

Ohio Statutes

§ 3902.50 — Definitions for R.C. 3902.50 to 3902.72

Ohio § 3902.50

Title 39Insurance

Ch. 3902Insurance Policies And Contracts

This text of Ohio § 3902.50 (Definitions for R.C. 3902.50 to 3902.72) is published on Counsel Stack Legal Research, covering Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ohio Rev. Code Ann. § 3902.50 (2026).

Text

As used in sections3902.50to3902.72of the Revised Code:

(A)"Ambulance" has the same meaning as in section4765.01of the Revised Code.

(B)"Clinical laboratory services" has the same meaning as in section4731.65of the Revised Code.

(C)"Cost sharing" means the cost to a covered person under a health benefit plan according to any copayment, coinsurance, deductible, or other out-of-pocket expense requirement.

(D)"Covered" or "coverage" means the provision of benefits related to health care services to a covered person in accordance with a health benefit plan.

(E)"Covered person," "health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section3922.01of the Revised Code.

(F)"Drug" has the same meaning as in section4729.01of the Revised Code.

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As used in sections3902.50to3902.72of the Revised Code:

(A) "Ambulance" has the same meaning as in section4765.01of the Revised Code.

(B) "Clinical laboratory services" has the same meaning as in section4731.65of the Revised Code.

(C) "Cost sharing" means the cost to a covered person under a health benefit plan according to any copayment, coinsurance, deductible, or other out-of-pocket expense requirement.

(D) "Covered" or "coverage" means the provision of benefits related to health care services to a covered person in accordance with a health benefit plan.

(E) "Covered person," "health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section3922.01of the Revised Code.

(F) "Drug" has the same meaning as in section4729.01of the Revised Code.

(G) "Emergency facility" has the same meaning as in section3701.74of the Revised Code.

(H) "Emergency services" means all of the following as described in 42 U.S.C. 1395dd:

(1) Medical screening examinations undertaken to determine whether an emergency medical condition exists;

(2) Treatment necessary to stabilize an emergency medical condition;

(3) Appropriate transfers undertaken prior to an emergency medical condition being stabilized.

(I) "Health care practitioner" has the same meaning as in section3701.74of the Revised Code.

(J) "Pharmacy benefit manager" has the same meaning as in section3959.01of the Revised Code.

(K) "Prior authorization requirement" means any practice implemented by a health plan issuer in which coverage of a health care service, device, or drug is dependent upon a covered person or a provider obtaining approval from the health plan issuer prior to the service, device, or drug being performed, received, or prescribed, as applicable. "Prior authorization requirement" includes prospective or utilization review procedures conducted prior to providing a health care service, device, or drug.

(L) "Unanticipated out-of-network care" means health care services, including clinical laboratory services, that are covered under a health benefit plan and that are provided by an out-of-network provider when either of the following conditions applies:

(1) The covered person did not have the ability to request such services from an in-network provider.

(2) The services provided were emergency services.

Last updated September 9, 2021 at 5:16 PM