Terms Used In Ohio Code > Chapter 3959 - Third-Party Administrators

• Administration fees: includes commissions earned or paid by any person relative to services performed by an administrator. See Ohio Code 3959.01
• Administrator: includes a pharmacy benefit manager. See Ohio Code 3959.01
• Aggregate excess insurance: means that type of coverage whereby the insurer agrees to reimburse the insured employer or trust for all benefits or claims paid during an agreement period on behalf of all covered persons under the plan or trust which exceed a stated deductible amount and subject to a stated maximum. See Ohio Code 3959.01
• Another: when used to designate the owner of property which is the subject of an offense, includes not only natural persons but also every other owner of property. See Ohio Code 1.02
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Bond: includes an undertaking. See Ohio Code 1.02
• Contract: A legal written agreement that becomes binding when signed.
• Contributions: means any amount collected from a covered person to fund the self-insured portion of any plan in accordance with the plan's provisions, summary plan descriptions, and contracts of insurance. See Ohio Code 3959.01
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Drug product reimbursement: means the amount paid by a pharmacy benefit manager to a contracted pharmacy for the cost of the drug dispensed to a patient and does not include a dispensing or professional fee. See Ohio Code 3959.01
• Fiscal year: means the twelve-month accounting period commencing on the date the plan is established and ending twelve months following that date, and each corresponding twelve-month accounting period thereafter as provided for in the summary plan description. See Ohio Code 3959.01
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fraud: Intentional deception resulting in injury to another.
• in writing: includes any representation of words, letters, symbols, or figures; this provision does not affect any law relating to signatures. See Ohio Code 1.59
• Insurer: means an entity authorized to do the business of insurance in this state or, for the purposes of this section, a health insuring corporation authorized to issue health care plans in this state. See Ohio Code 3959.01
• Managed care organization: means an entity that provides medical management and cost containment services and includes a medicaid managed care organization, as defined in section 5167. See Ohio Code 3959.01
• Maximum allowable cost: means a maximum drug product reimbursement for an individual drug or for a group of therapeutically and pharmaceutically equivalent multiple source drugs that are listed in the United States food and drug administration's approved drug products with therapeutic equivalence evaluations, commonly referred to as the orange book. See Ohio Code 3959.01
• Maximum allowable cost list: means a list of the drugs for which a pharmacy benefit manager imposes a maximum allowable cost. See Ohio Code 3959.01
• Person: includes an individual, corporation, business trust, estate, trust, partnership, and association. See Ohio Code 1.59
• pharmacy: means a pharmacy located in this state participating in either the network of a pharmacy benefit manager or in a health care or pharmacy benefit plan through a direct contract or through a contract with a pharmacy services administration organization, group purchasing organization, or another contracting agent. See Ohio Code 3959.01
• Pharmacy benefit manager: includes the state pharmacy benefit manager selected under section 5167. See Ohio Code 3959.01
• Plan: means any arrangement in written form for the payment of life, dental, health, or disability benefits to covered persons defined by the summary plan description and includes a drug benefit plan administered by a pharmacy benefit manager. See Ohio Code 3959.01
• Plan sponsor: means the person who establishes the plan. See Ohio Code 3959.01
• Rule: includes regulation. See Ohio Code 1.59
• Specific excess insurance: means that type of coverage whereby the insurer agrees to reimburse the insured employer or trust for all benefits or claims paid during an agreement period on behalf of a covered person in excess of a stated deductible amount and subject to a stated maximum. See Ohio Code 3959.01
• state: means the state of Ohio. See Ohio Code 1.59
• Statute: A law passed by a legislature.
• Subpoena: A command to a witness to appear and give testimony.
• Summary plan description: means the written document adopted by the plan sponsor which outlines the plan of benefits, conditions, limitations, exclusions, and other pertinent details relative to the benefits provided to covered persons thereunder. See Ohio Code 3959.01
• United States: includes all the states. See Ohio Code 1.59