Ohio § 3923.81

§ 3923.81.

(A) If a person is covered by a health benefit plan issued by a sickness and accident

insurer, health insuring corporation, or multiple employer welfare arrangement and

the person is required to pay for health care costs out-of-pocket or with funds from

a savings account, the amount the person is required to pay to a health care provider

or pharmacy shall not exceed the amount the sickness and accident insurer, health

insuring corporation, or multiple employer welfare arrangement would pay under applicable

reimbursement rates negotiated with the provider or pharmacy.  This division does not preclude a person from reaching an agreement with a health

care provider or pharmacy on terms that are more favorable to the person than negotiated

reimbursement rates that otherwise would apply as long as the claim submitted reflects

the alternative amount negotiated, except that a health care provider or pharmacy

shall not waive all or part of a copay or deductible if prohibited by any other provision

of the Revised Code.  The requirements of this division do not apply to amounts owed to a provider or

pharmacy with whom the sickness and accident insurer, health insuring corporation,

or multiple employer welfare arrangement has no applicable negotiated reimbursement

rate. (B) Each sickness and accident insurer, health insuring corporation, or multiple employer

welfare arrangement shall establish and maintain a system whereby a person covered

by a health benefit plan may obtain information regarding potential out of pocket

costs for services provided by in-network providers. (C) As used in this section: (1) “ Health benefit plan ” means any policy of sickness and accident insurance or any policy, contract, or

agreement covering one or more “basic health care services,” “supplemental health

care services,” or “specialty health care services,” as defined in section 1751.01 of the Revised Code , offered or provided by a health insuring corporation or by a sickness and accident

insurer or multiple employer welfare arrangement. (2) “ Reimbursement rates ” means any rates that apply to a payment made by a sickness and accident insurer,

health insuring corporation, or multiple employer welfare arrangement for charges

covered by a health benefit plan. (3) “ Savings account ” includes health savings accounts, health reimbursement arrangements, flexible savings

accounts, medical savings accounts, and similar accounts and arrangements.