Ohio § 3902.50

§ 3902.50.

As used in sections 3902.50 to 3902.72 of the Revised Code : (A) “Ambulance” has the same meaning as in section 4765.01 of the Revised Code . (B) “Clinical laboratory services” has the same meaning as in section 4731.65 of 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 section 3922.01 of the Revised Code . (F) “Drug” has the same meaning as in section 4729.01 of the Revised Code . (G) “Emergency facility” has the same meaning as in section 3701.74 of 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 section 3701.74 of the Revised Code . (J) “Pharmacy benefit manager” has the same meaning as in section 3959.01 of 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.