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Chapter 4151

Third-Party Administrators

Subchapter A. General Provisions

4151.001 Definitions 4151.002 Exemptions 4151.0021 Applicability to Certain Processing Agents 4151.0022 Nonapplicability 4151.003 Applicability of Other Provisions of Code 4151.0031 Market Analysis 4151.004 Applicability to Certain Insurers and Health Maintenance Organizations 4151.005 Administrator Not Insurance Agent 4151.0051 Referral to Adjuster by Administrator 4151.006 Rules

Subchapter B. Certificate of Authority

4151.051 Certificate of Authority Required 4151.052 Application 4151.053 Approval of Application 4151.054 Denial of Application 4151.055 Fidelity Bond Required 4151.056 Duration of Certificate of Authority

Subchapter C. Powers and Duties of Administrators and Insurers

4151.101 Written Agreement with Insurer or Plan Sponsor Required 4151.102 Contents of Written Agreement 4151.103 Retention of Written Agreement; Inspection by Commissioner 4151.104 Notice of Use of Administrator's Services 4151.1041 Referral by Insurer 4151.1042 Responsibilities of Insurer; Audit and Review Requirements 4151.105 Payments to Administrator 4151.106 Certain Funds Collected or Received by Administrator 4151.107 Delivery or Deposit of Certain Funds Received by Administrator 4151.108 Withdrawals from Fiduciary Account 4151.109 Payment of Claims from Fiduciary Account Prohibited 4151.110 Underwriting Standards 4151.111 Adjudication of Claims 4151.112 Maintenance of Books and Records 4151.113 Access to Books and Records 4151.114 Disposition of Books and Records on Termination of Written Agreement 4151.115 Confidentiality of Personal Information 4151.116 Advertising 4151.117 Compensation of Administrator

Subchapter D. Pharmacy Benefit Plans

4151.151 Definition 4151.152 Identification Cards 4151.153 Disclosure of Certain Patient Information Prohibited 4151.1531 Security of Patient Data 4151.154 Discount Health Care Programs 4151.155 Certain Disclosures and Communications by Pharmacist or Pharmacy Protected

Subchapter E. Department Regulation of Administrators

4151.201 Examination of Administrator 4151.202 Contents of Examination; on-Site Evaluation 4151.203 Cost of Examination 4151.204 Examination under Oath 4151.205 Annual Report 4151.206 Fees 4151.210 Effect of Revocation of Other Certificates 4151.211 Restrictions on Acquisition of Ownership Interest 4151.212 Maintenance of Qualifications Required

Subchapter F. Workers' Compensation Benefit Plans

4151.251 Definition 4151.252 Application 4151.253 Agreements Between Administrators and Carriers 4151.254 Agreements Between Administrators and Employers 4151.255 Administrator Compensation 4151.256 Large Deductible Policies 4151.257 Rules

Subchapter G. Disciplinary Actions; Penalties

4151.301 Grounds for Denial, Suspension, or Revocation of Certificate of Authority 4151.302 Remedies for Violation of Insurance Laws or Commissioner Rules 4151.303 Probated Suspension 4151.304 Hearing 4151.305 Application for Certificate of Authority After Denial or Revocation 4151.306 Disciplinary Proceeding for Conduct Committed Before Surrender or Forfeiture of Certificate 4151.307 Emergency Certificate Suspension 4151.308 General Administrative Sanctions 4151.309 Criminal Penalty