Ohio § 3923.601

§ 3923.601.

(A)(1) This section applies to both of the following: (a) A sickness and accident insurer that issues or requires the use of a standardized

identification card or an electronic technology for submission and routing of prescription

drug claims pursuant to a policy, contract, or agreement for health care services; (b) A person that a sickness and accident insurer contracts with to issue a standardized

identification card or an electronic technology described in division (A)(1)(a) of

this section. (2) Notwithstanding division (A)(1) of this section, this section does not apply to the

issuance or required use of a standardized identification card or an electronic technology

for the submission and routing of prescription drug claims in connection with any

of the following: (a) Any individual or group policy of sickness and accident insurance covering only accident,

credit, dental, disability income, long-term care, hospital indemnity, medicare supplement,

medicare, tricare, specified disease, or vision care;  coverage under a one-time-limited-duration

policy that is less than twelve months;  coverage issued as a supplement to liability

insurance;  insurance arising out of workers' compensation or similar law;  automobile

medical payment insurance;  or insurance under which benefits are payable with or

without regard to fault and which is statutorily required to be contained in any liability

insurance policy or equivalent self-insurance. (b) Coverage provided under the medicaid program. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators,

as defined in section 3959.01 of the Revised Code , to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes

the application of this section to the plan and its administrators. (B) A standardized identification card or an electronic technology issued or required

to be used as provided in division (A)(1) of this section shall contain uniform prescription

drug information in accordance with either division (B)(1) or (2) of this section. (1) The standardized identification card or the electronic technology shall be in a format

and contain information fields approved by the national council for prescription drug

programs or a successor organization, as specified in the council's or successor organization's

pharmacy identification card implementation guide in effect on the first day of October

most immediately preceding the issuance or required use of the standardized identification

card or the electronic technology. (2) If the insurer or person under contract with the insurer to issue a standardized

identification card or an electronic technology requires the information for the submission

and routing of a claim, the standardized identification card or the electronic technology

shall contain any of the following information: (a) The insurer's name; (b) The insured's name, group number, and identification number; (c) A telephone number to inquire about pharmacy-related issues; (d) The issuer's international identification number, labeled as “ANSI BIN” or “RxBIN”; (e) The processor's control number, labeled as “RxPCN”; (f) The insured's pharmacy benefits group number if different from the insured's medical

group number, labeled as “RxGrp.” (C) If the standardized identification card or the electronic technology issued or required

to be used as provided in division (A)(1) of this section is also used for submission

and routing of nonpharmacy claims, the designation “Rx” is required to be included

as part of the labels identified in divisions (B)(2)(d) and (e) of this section if

the issuer's international identification number or the processor's control number

is different for medical and pharmacy claims. (D) Each sickness and accident insurer described in division (A) of this section shall

annually file a certificate with the superintendent of insurance certifying that it

or any person it contracts with to issue a standardized identification card or electronic

technology for submission and routing of prescription drug claims complies with this

section. (E)(1) Except as provided in division (E)(2) of this section, if there is a change in the

information contained in the standardized identification card or the electronic technology

issued to an insured, the insurer or person under contract with the insurer to issue

a standardized identification card or an electronic technology shall issue a new card

or electronic technology to the insured. (2) An insurer or person under contract with the insurer is not required under division

(E)(1) of this section to issue a new card or electronic technology to an insured

more than once during a twelve-month period. (F) Nothing in this section shall be construed as requiring an insurer to produce more

than one standardized identification card or one electronic technology for use by

insureds accessing health care benefits provided under a policy of sickness and accident

insurance.