Regulatory Review

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Rate Review

OHIC reviews the premiums for comprehensive/major medical plans, Medicare supplement plans, and limited benefit plans sold in the state to ensure they are consistent with the public interest and proper business conduct. Rates may be approved, modified, or rejected.

Form Review

OHIC reviews coverage documents for comprehensive/major medical plans, Medicare supplement plans, and limited benefit plans sold in the state to ensure they are consistent with the public interest and federal and state requirements. Forms may be approved, modified, or rejected.

Discount Medical Plan Organization Application Review

Network Plan Review

OHIC certifies all network plans in the state to ensure consumer protections are in place such as network adequacy and that provider credentialing and contracting requirements are met.

Benefit Determination Review

OHIC certifies all benefit determination and UR agents to ensure consumer protections are in place such as timely approval of and payment for covered services and that required denial and appeal processes are followed.

Medicare Supplement Plan Rate Requests

Social and Human Service Programs Review

OHIC conducts comprehensive reviews of all social and human service programs having a contract with or licensed by the state.