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2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3956 | Life and Health Insurance Guaranty Association › Section 3956.20 | Offset of Assessments Against Premium or Franchise Tax Liability.

Effective:
September 13, 2022
Latest Legislation:
Senate Bill 273 - 134th General Assembly
(A)(1) A member insurer may offset against its premium or franchise tax liability twenty per cent of the assessment described in division (H) of section 3956.09 of the Revised Code in each of the five calendar years following the fiscal biennium in which the assessment was paid. The offsets shall be allowed on a year-per-year basis commencing with the first tax payment due after the fiscal biennium in which the assessment was paid.
(2) If the aggregate total of the assessments described in division (A)(1) of this section and eligible for offset in a particular year exceeds a member insurer's tax liability to this state for such year, the aggregate total of the remaining eligible assessments, notwithstanding the five-year limitation set forth in division (A)(1) of this section, may be offset against such tax liability in future years.
(3) If a member insurer ceases doing business, all uncredited assessments may be credited against its premium or franchise tax liability for the year it ceases doing business.
(4) The Ohio life and health insurance guaranty association may require a member insurer to report any offset to the association.
(B) A member insurer that is exempt from taxes described in division (A) of this section may recoup its assessments by a surcharge on its premiums in a sum reasonably calculated to recoup the assessments over a reasonable period of time, as approved by the superintendent. Amounts recouped shall not be considered premiums for any other purpose, including the computation of gross premium tax, the medical loss ratio, or agent commission. If a member insurer collects excess surcharges, the member insurer shall remit the excess amount to the association, and the excess amount shall be applied to reduce future assessments in the appropriate account.
(C) Any sums that are acquired by member insurers by refund from the association pursuant to division (F) of section 3956.09 of the Revised Code and that have been offset, prior to the refund, against premium or franchise tax liability as provided in division (A) of this section shall be paid by such member insurers to this state in the manner the superintendent of insurance requires. The association shall notify the superintendent that the refunds have been made.
Last updated July 15, 2022 at 11:26 AM
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.04 | Administrators Tested and Licensed by Superintendent.

Effective:
December 2, 1996
Latest Legislation:
House Bill 670 - 121st General Assembly
(A) Administrators may be tested and shall be licensed by the superintendent of insurance in accordance with rules adopted by the superintendent.
(B) An administrator who has been licensed or certified by the state of the administrator's domicile under a statute or rule similar to sections 3959.01 to 3959.16 of the Revised Code shall, upon application, be licensed without testing, provided the state of domicile recognizes and grants licenses to administrators of this state who have obtained licenses under such sections.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.05 | License Requirement.

Effective:
May 18, 1988
Latest Legislation:
House Bill 284 - 117th General Assembly
No person shall solicit a plan or sponsor of a plan to act as an administrator for, or provide administrative services to, a plan or sponsor of a plan that is either domiciled in this state or has its principal headquarters or principal administrative office in this state unless the person is duly licensed under sections 3959.01 to 3959.16 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.06 | Application for License - Filing Fee.

Effective:
December 2, 1996
Latest Legislation:
House Bill 670 - 121st General Assembly
(A) An administrator shall file with the superintendent of insurance an application for a license on a form prescribed by the superintendent.
(B) All applications for a license shall be accompanied by a nonrefundable filing fee of two hundred dollars per application made payable to the department of insurance.
(C) All fees collected under this section and under section 3959.10 of the Revised Code shall be paid into the state treasury to the credit of the department of insurance operating fund created under section 3901.021 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.08 | Denying Application for License.

Effective:
December 2, 1996
Latest Legislation:
House Bill 670 - 121st General Assembly
If the superintendent of insurance denies the application for license, the superintendent shall promptly notify the applicant of the denial and the reasons for the denial within thirty days of the date the application is denied by the superintendent. The notice shall advise the applicant of the applicant's right to request a hearing within thirty days from the date of the mailing of the notice.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.09 | Issuing License and Certificate of Authority.

Effective:
May 18, 1988
Latest Legislation:
House Bill 284 - 117th General Assembly
Upon approval of the application for an administrators license and payment of appropriate filing fees, the applicant shall be granted a license by the superintendent of insurance and an appropriate certificate of authority to operate as an administrator will be issued to the applicant. The license shall be issued, effective on the date the application is approved by the superintendent or board, or both, for a term expiring on the following June 30. The license may be renewed annually for a period of one year commencing July 1.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.10 | License Renewal.

Effective:
December 2, 1996
Latest Legislation:
House Bill 670 - 121st General Assembly
(A) The superintendent of insurance shall, at least sixty days before the expiration of the administrators license granted by the superintendent, provide a renewal notice on a form approved by the superintendent.
(B) The renewal application shall require the payment of a renewal fee of three hundred dollars and the payment shall be made prior to the expiration date of the license. Failure to make the renewal payment shall result in the cancellation of the license.
(C) In the event of nonpayment of renewal license fees within the time period prescribed by the superintendent, the license shall be canceled and subject to reinstatement on the basis of a new filing as provided in section 3959.04 of the Revised Code, except that the superintendent shall charge a pro rata renewal fee of twenty-five dollars for each month that the license is to be in effect.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.11 | Written Agreement to Act as Administrator Between the Administrator and the Plan Sponsor.

Effective:
May 18, 1988
Latest Legislation:
House Bill 284 - 117th General Assembly
(A) No person may act as an administrator without a written agreement between the administrator and the plan sponsor. Such written agreement shall be retained as part of the official records of the administrator for the duration of the agreement and for five years thereafter. Each such agreement shall contain, at a minimum, all of the following information:
(1) The term of the agreement;
(2) An explanation of the services to be performed by the administrator;
(3) The method and rate of compensation to be paid by the plan sponsor to the administrator for services rendered;
(4) Provisions for the renewal and termination of the agreement.
(B) Every administrator shall maintain in its principal office or branch office, if any, for the duration of the agreement with the plan sponsor, customary books and records of all transactions and information relative to covered persons or beneficiaries.
(C) Each administrator duly licensed under sections 3959.01 to 3959.16 of the Revised Code shall at all times maintain any required insurance coverage or bond as provided for and mandated by the "Employee Retirement and Income Security Act of 1974," 88 Stat. 829, 29 U.S.C. 1001, as amended.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.13 | Report of Felony Conviction.

Effective:
January 1, 2004
Latest Legislation:
House Bill 490 - 124th General Assembly
Any person who, while licensed as an administrator, is convicted of a felony, shall report the conviction to the superintendent of insurance within thirty days of the entry date of the judgment of conviction. Within that thirty-day period, the person shall also provide the superintendent with a copy of the judgment, the commitment order or the order imposing a community control sanction, and any other relevant documents.
As used in this section, "community control sanction" has the same meaning as in section 2929.01 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.14 | Administrator Prohibitions.

Effective:
May 18, 1988
Latest Legislation:
House Bill 284 - 117th General Assembly
No administrator shall do any of the following:
(A) Use plan sponsor funds for any purpose or purposes not specifically set forth in written form by the administrator;
(B) Fail to disclose in written solicitation material and on an on-going basis, at least once annually, to the plan sponsor all of the following:
(1) All fixed plan costs, identifying what each fixed cost includes;
(2) Levels of the specific excess insurance stop-loss deductible;
(3) The aggregate excess insurance stop-loss attachment point factors, including any minimum attachment point factors;
(4) The names of all insurance carriers providing protection for the plan sponsor's plans, and any ownership relationship of five per cent or more between the administrator and such insurance carriers.
(C) Fail to remit insurance company premiums within the policy period or within the time period agreed to in writing between the insurance company and the administrator;
(D) Fail to disclose in written form the method of collecting and holding any plan sponsor's funds.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.16 | Preemption of Federal Law.

Effective:
May 18, 1988
Latest Legislation:
House Bill 284 - 117th General Assembly
Sections 3959.01 to 3959.16 of the Revised Code do not apply to an employer's self-insurance plan to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of any provisions of those sections to such plan.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.17 | Effect of Child Support Default on License.

Effective:
March 22, 2001
Latest Legislation:
Senate Bill 180 - 123rd General Assembly
On receipt of a notice pursuant to section 3123.43 of the Revised Code, the superintendent of insurance shall comply with sections 3123.41 to 3123.50 of the Revised Code and any applicable rules adopted under section 3123.63 of the Revised Code with respect to a license issued pursuant to this chapter.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3959 | Third-Party Administrators › Section 3959.20 | Prohibited Acts Regarding Cost-Sharing, Pharmacy Claims for Reimbursement, Fees.

Effective:
October 17, 2019
Latest Legislation:
House Bill 166 - 133rd General Assembly
(A) As used in this section:
(1) "Cost-sharing" means the cost to an individual insured under a health benefit plan according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the plan.
(2) "Health benefit plan" and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code.
(3) "Pharmacy audit" has the same meaning as in section 3901.81 of the Revised Code.
(4) "Pharmacy benefit manager" and "administrator" have the same meanings as in section 3959.01 of the Revised Code.
(B) No health plan issuer, pharmacy benefit manager, or any other administrator shall require cost-sharing in an amount, or direct a pharmacy to collect cost-sharing in an amount, greater than the lesser of either of the following from an individual purchasing a prescription drug:
(1) The amount an individual would pay for the drug if the drug were to be purchased without coverage under a health benefit plan;
(2) The net reimbursement paid to the pharmacy for the prescription drug by the health plan issuer, pharmacy benefit manager, or administrator.
(C)(1) No health plan issuer, pharmacy benefit manager, or administrator shall retroactively adjust a pharmacy claim for reimbursement for a prescription drug unless the adjustment is the result of either of the following:
(a) A pharmacy audit conducted in accordance with sections 3901.811 to 3901.814 of the Revised Code;
(b) A technical billing error.
(2) No health plan issuer, pharmacy benefit manager, or administrator shall charge a fee related to a claim unless the amount of the fee can be determined at the time of claim adjudication.
(D) The department of insurance shall create a web form that consumers can use to submit complaints relating to violations of this section.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.02 | Requirements for Transacting Business.

Effective:
October 26, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
(A) No risk retention group organized under the laws of this state shall transact business in this state unless both of the following apply:
(1) It has capital and surplus in an amount of not less than two million five hundred thousand dollars, and the superintendent of insurance issues a certificate of authority to transact the business of liability insurance as a risk retention group. Section 3960.03 of the Revised Code applies to the risk retention group only to the extent that that section does not conflict with or limit the operation of any law or rule of this state applicable to liability insurance companies.
(2) The superintendent has approved a plan of operation or a feasibility study submitted to the superintendent by the risk retention group applicable to the lines of liability insurance to be offered by the risk retention group. The risk retention group shall submit an appropriate revision, in the event of any subsequent material change in any item of the plan of operation or feasibility study, within ten days of the change. The group shall not offer any additional kinds of liability insurance, in this state or in any other state, until a revision of the plan or study is approved by the commissioner of insurance of each state.
(B) The superintendent, upon the filing of an application by a risk retention group for a certificate of authority to transact the business of liability insurance in this state, shall provide summary information to the national association of insurance commissioners including the name of the risk retention group, the identity of its initial members, the identity of the individuals who organized it or who will provide administrative services or otherwise influence or control its activities, the amount and nature of its initial capitalization, the coverages to be afforded by it, and the states in which it intends to operate. As part of its application, the risk retention group also shall provide such information in summary form.
(C) The laws of this state apply to risk retention groups doing business in the state, except as preempted by the federal "Risk Retention Amendments of 1986," 100 Stat. 3170, 15 U.S.C.A. 3901, as amended, or other federal laws, and except to the extent modified in sections 3960.01 to 3960.13 of the Revised Code.
(D) Each risk retention group domiciled in this state is liable for the payment of franchise taxes or taxes on premiums of direct business for risks resident or located within this state. A risk retention group domiciled in this state also is subject to any taxes, applicable fines, and penalties as are any domiciled insurers.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.04 | Notices on Application Forms and Policies.

Effective:
October 27, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
(A)(1) Every application form for insurance from a risk retention group and every policy or certificate of insurance issued by a risk retention group shall contain in ten-point type on the front page and the declaration page, the following notice:
"Notice
This policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and regulations of your state. State insurance insolvency guaranty funds are not available for your risk retention group."
(2) No risk retention group shall fail to comply with the notice requirement of division (A)(1) of this section.
(B) No risk retention group shall do any of the following:
(1) Solicit or sell insurance to a person who is not eligible for membership in it;
(2) Solicit or sell insurance or operate as a risk retention group if it is in a hazardous financial condition or is financially impaired.
(C) No risk retention group shall do business in this state if an insurance company is directly or indirectly a member or owner of the risk retention group, except if all of the members of the risk retention group are insurance companies.
(D) The terms of any insurance policy issued by any risk retention group shall not provide, or be construed to provide, coverage prohibited generally by statute of this state or declared unlawful by the highest court of the state whose law applies to the policy.
(E) Sections 3901.19 to 3901.26 of the Revised Code apply to risk retention groups and to their agents and representatives.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.05 | No Coverage by Ohio Insurance Guaranty Association or Similar Mechanism.

Effective:
October 26, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
(A) Sections 3955.01 to 3955.19 of the Revised Code do not apply to risk retention groups. No risk retention group shall be required or permitted to join or contribute financially to the Ohio insurance guaranty association or similar mechanism in this state. No risk retention group, or its insureds or claimants against its insureds, shall receive any benefit from any such association or mechanism for claims arising under the insurance policies issued by the risk retention group.
(B) When the laws of this state or any of its political subdivisions require any person to obtain liability insurance as a condition of licensure, approval, permission, or other authorization, the insurance may be obtained from a risk retention group as defined in division (J) of section 3960.01 of the Revised Code, if the public agency administering those laws has made a determination that the protection of the Ohio insurance guaranty association provided by Chapter 3955. of the Revised Code is not necessary and that insurance provided by a risk retention group is acceptable to the public agency under the standards of the law that it administers.
(C) When a purchasing group obtains insurance covering its members' risks from an insurer not authorized in this state or a risk retention group, the risks are not covered by any insurance guaranty association or similar mechanism in this state.
(D) When a purchasing group obtains insurance covering its members' risks from an authorized insurer, only risks resident or located in this state shall be covered by the state guaranty association subject to Chapter 3955. of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.06 | Applicability of Laws to Purchasing Group.

Effective:
June 27, 2005
Latest Legislation:
Senate Bill 124 - 126th General Assembly
(A) A purchasing group and its insurer or insurers are subject to all applicable laws of this state, except that a purchasing group and its insurer or insurers, in regard to liability insurance for the purchasing group, are exempt from any law that does any of the following:
(1) Prohibits the establishment of a purchasing group;
(2) Makes it unlawful for an insurer to provide or offer to provide insurance on a basis providing, to a purchasing group or its members, advantages based on their loss and expense experience not afforded to other persons with respect to rates, policy forms, coverages, or other matters;
(3) Prohibits a purchasing group or its members from purchasing insurance on a group basis described in division (A)(2) of this section;
(4) Prohibits a purchasing group from obtaining insurance on a group basis because the group has not been in existence for a minimum period of time or because any member has not belonged to the group for a minimum period of time;
(5) Requires that a purchasing group have a minimum number of members, common ownership or affiliation, or a certain legal form;
(6) Requires that a certain percentage of a purchasing group obtain insurance on a group basis;
(7) Otherwise discriminates against a purchasing group or any of its members;
(8) Requires that any insurance policy issued to a purchasing group or any of its members be countersigned by an insurance agent or broker residing in this state.
(B) The superintendent of insurance may require or exempt a risk retention group from participation in any joint underwriting association established under section 3930.03 or in the plan established under section 4509.70 of the Revised Code. Any risk retention group that is required to participate under this division shall submit sufficient information to the superintendent to enable the superintendent to apportion on a nondiscriminatory basis the risk retention group's proportionate share of losses and expenses.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.07 | Requirements of Purchasing Group for Transacting Business.

Effective:
January 1, 2021
Latest Legislation:
House Bill 339 - 133rd General Assembly
(A) No purchasing group shall conduct business in this state unless it has done both of the following:
(1) Issued a notice to the superintendent of insurance that does all of the following:
(a) Identifies the state in which the purchasing group is domiciled and all other states in which the group intends to do business;
(b) Specifies the lines and classifications of liability insurance that the purchasing group intends to purchase and specifies the method by which and the person or persons, if any, through whom insurance will be offered to its members whose risks are resident or located in this state;
(c) Identifies the name and domicile of the insurance company from which the purchasing group intends to purchase its insurance;
(d) Identifies the principal place of business of the purchasing group;
(e) Provides any other information that the superintendent may require to verify that the purchasing group is qualified under division (I) of section 3960.01 of the Revised Code.
A purchasing group, within ten days, shall notify the superintendent of any changes in any of the items set forth in division (A)(1) this section.
(2) Registered with the superintendent, paid a filing fee as determined by the superintendent, and consented to the exercise of jurisdiction over it by the superintendent and the courts of this state. The fee shall be paid into the state treasury to the credit of the department of insurance operating fund pursuant to section 3901.021 of the Revised Code.
Division (A)(2) of this section does not apply to a purchasing group to which all of the following apply:
(a) It was domiciled in any state before April 1, 1986, and on and after October 27, 1986;
(b) It purchased insurance from an insurance carrier licensed in any state before and after October 27, 1986;
(c) It was a purchasing group meeting the requirements of the federal "Product Liability Risk Retention Act of 1981," 95 Stat. 949, 15 U.S.C.A. 3901, before October 27, 1986;
(d) It does not purchase insurance that was not authorized for purposes of an exemption under that act, as in effect before October 27, 1986.
(B) Each purchasing group that is required to give notice pursuant to division (A)(1) of this section also shall furnish any information that may be required by the superintendent to do both of the following:
(1) Determine where the purchasing group is located;
(2) Determine appropriate tax treatment.
(C) Sections 3937.01 to 3937.17 of the Revised Code apply to admitted insurers that provide insurance to purchasing groups.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.08 | Restricting Purchases of Insurance.

Effective:
October 26, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
(A) No purchasing group shall purchase insurance from a risk retention group that is not chartered, or from an insurer that is not admitted to do business, in the state in which the purchasing group is located, unless the purchase is effected through an agent or broker licensed in this state to sell surplus lines.
(B)(1) A purchasing group that obtains liability insurance from an insurer not admitted in this state or a risk retention group shall inform, as provided in division (B)(2) of this section, each of the members of such group that have a risk resident or located in this state that the risk is not protected by an insurance insolvency guaranty association or mechanism in this state, and that the risk retention group or insurer may not be subject to all insurance laws and regulations of this state.
(2)(a) Every application form for insurance from a purchasing group and every policy or certificate of insurance issued by a purchasing group shall contain in ten-point type on the front page the following notice:
"Notice
Your risk is not protected by the state
insurance insolvency fund, and the insurer
or the risk retention group from which
your purchasing group obtained its insurance
may not be subject to all of the insurance
laws and rules of this state."
(b) No purchasing group shall fail to comply with the notice requirements of division (B)(2)(a) of this section.
(C) No purchasing group shall purchase insurance providing for a deductible or self-insured retention applicable to the group as a whole. Coverage may provide for a deductible or self-insured retention applicable to individual members.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.09 | Premium Taxes or Taxes on Premiums Paid for Coverage of Risks.

Effective:
October 26, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
Premium taxes or taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any members of the purchasing group shall be imposed and paid in accordance with the following:
(A) Imposed at the same rate and subject to the same interest, fines, and penalties as those applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insureds;
(B) Paid first by the insurance source; if not by the source, then by the agent or broker for the purchasing group; if not by the agent or broker, then by the purchasing group; and if not by the purchasing group, then by each of its members.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.10 | Authority and Powers of Superintendent of Insurance.

Effective:
October 26, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
(A) The superintendent of insurance may exercise any powers to enforce the insurance laws of this state applicable to risk retention groups and purchasing groups, except those that are specifically preempted by the federal "Product Liability Risk Retention Act of 1981," 95 Stat. 949, 15 U.S.C.A. 3901, as amended by the federal "Risk Retention Amendments of 1986," 100 Stat. 3170, 15 U.S.C.A. 3901, as amended.
(B) The authority of the superintendent under division (A) of this section includes, but is not limited to, the superintendent's administrative authority under the laws of this state to investigate, issue subpoenas, conduct depositions and hearings, issue orders, and impose penalties. Actions by the superintendent seeking an injunction are subject to the restrictions in the federal "Risk Retention Amendments of 1986," 100 Stat. 3170, 15 U.S.C.A. 3901, as amended.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.11 | Soliciting, Negotiating, or Procuring Liability Insurance Restricted to Licensed Agents and Brokers.

Effective:
March 20, 2019
Latest Legislation:
Senate Bill 273 - 132nd General Assembly
(A) No person shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance in this state from a risk retention group unless the person is licensed as an insurance agent or broker in accordance with Chapter 3905. of the Revised Code.
(B) No person shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance in this state for a purchasing group from an authorized insurer or a risk retention group chartered in a state unless the person is licensed as an insurance agent or broker in accordance with Chapter 3905. of the Revised Code.
(C) No person shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance coverage in this state for any member of a purchasing group under a purchasing group's policy unless the person is licensed as an insurance agent or broker in accordance with Chapter 3905. of the Revised Code.
(D) No person shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance from an insurer not authorized to do business in this state, or from a domestic insurer designated as a domestic surplus lines insurer pursuant to section 3905.332 of the Revised Code, on behalf of a purchasing group located in this state unless the person is licensed as a surplus line broker in accordance with section 3905.30 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.12 | Adoption of Rules for Enforcement.

Effective:
October 26, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
The superintendent of insurance may adopt any rules necessary or desirable for the enforcement of sections 3960.01 to 3960.13 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3960 | Risk Retention › Section 3960.13 | Enforcement Powers of Superintendent of Insurance.

Effective:
October 26, 1989
Latest Legislation:
House Bill 105 - 118th General Assembly
The superintendent of insurance, after notice and an opportunity for hearing under Chapter 119. of the Revised Code, may do all of the following:
(A) Suspend, revoke, or refuse to renew the certificate of authority of a risk retention group that violates any provision of sections 3960.01 to 3960.13 of the Revised Code for which a specific sanction is not imposed by the law applicable to liability insurance companies admitted to do business in this state;
(B) Impose a civil penalty not to exceed three thousand five hundred dollars for each violation of the type described in division (A) of this section, but not to exceed an aggregate penalty of thirty-five thousand dollars in any six-month period upon the group or any member of the group that participates in the violation;
(C) Obtain injunctive relief to restrain or prevent a violation or threatened violation of the type described in division (A) of this section.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3961 | Discount Medical Plans › Section 3961.02 | Provider Agreement Required for Discounted Medical Services.

Effective:
March 23, 2007
Latest Legislation:
Senate Bill 5 - 126th General Assembly
(A) A discount medical plan organization shall not offer to members, or advertise to prospective members, discounted medical services unless the services are offered pursuant to a provider agreement. A discount medical plan organization may enter into a provider agreement directly with a provider, indirectly through a provider network to which a provider belongs, or through another discount medical plan organization that contracts with providers directly or through a provider network.
(B) A provider agreement between a discount medical plan organization and a provider shall contain all of the following:
(1) A list of medical services and products offered at a discount;
(2) The discounted rates for medical services or a fee schedule that reflects the provider's discounted rates;
(3) A statement that the provider will not charge members more than the discounted rates described in division (B)(2) of this section.
(C) A provider agreement between a discount medical plan organization and a provider network shall require the provider network to do all of the following:
(1) Maintain an up-to-date list of the provider network's contracted providers and supply that list to the discount medical plan organization on a monthly basis;
(2) Have a written agreement with each provider who offers discounted medical services that contains both of the following:
(a) The items listed in division (B) of this section;
(b) A grant of authority that allows the provider network to contract with discount medical plan organizations on behalf of the provider.
(D) A provider agreement between a discount medical plan organization and another discount medical plan organization shall require that the other discount medical plan organization have provider agreements in place that comply with division (A) of this section and division (B) or (C) of this section, as applicable.
(E) A discount medical plan organization shall keep for the duration of the agreement a copy of each provider agreement into which the organization has entered.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3961 | Discount Medical Plans › Section 3961.03 | Written Agreement With Marketer Required.

Effective:
March 23, 2007
Latest Legislation:
Senate Bill 5 - 126th General Assembly
(A) Prior to a discount medical plan organization allowing a marketer to market, promote, sell, or distribute a discount medical plan, the organization shall enter into a written agreement with the marketer. This agreement shall prohibit the marketer from using or issuing any advertising, marketing materials, brochures, or discount medical cards without the organization's written approval.
(B) A discount medical plan organization is bound by and responsible for a marketer's activities that are within the scope of the marketer's agency relationship with the organization.
(C) A discount medical plan organization shall approve in writing all advertisements, marketing materials, brochures, and discount cards prior to a marketer using these materials to market, promote, sell, or distribute the discount medical plan.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3961 | Discount Medical Plans › Section 3961.05 | Prohibited Conduct.

Effective:
March 23, 2007
Latest Legislation:
Senate Bill 5 - 126th General Assembly
A discount medical plan organization shall not do any of the following:
(A) Except when otherwise permitted in sections 3961.01 to 3961.09 of the Revised Code, as a disclaimer of any relationship between discount medical plan benefits and insurance, or in a description of an insurance product connected with a discount medical plan, use the term "insurance" in the organization's advertisements, marketing material, brochures, or discount medical plan cards.
(B) Use in the organization's advertisements, marketing material, brochures, or discount medical plan cards the terms "health plan," "coverage," "benefits," "copay," "copayments," "deductible," "pre-existing conditions," "guaranteed issue," "premium," "PPO," "preferred provider organization," or any other terms in a manner that could mislead a person into believing that the discount medical plan is health insurance.
(C) Make misleading, deceptive, or fraudulent statements or representations regarding the terms or benefits of the discount medical plan, including, but not limited to, statements or representations regarding discounts, range of discounts, or access to those discounts offered under the discount medical plan.
(D) Except for hospital services, have restrictions on access to discount medical plan providers, including, but not limited to, waiting and notification periods.
(E) Pay providers fees for medical services or collect or accept money from a member to pay a provider for medical services received under the discount medical plan.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3961 | Discount Medical Plans › Section 3961.06 | Cancellation of Membership in Plan.

Effective:
March 23, 2007
Latest Legislation:
Senate Bill 5 - 126th General Assembly
(A) A discount medical plan organization shall permit members to cancel membership in a discount medical plan at any time.
(B) If a member gives notice of cancellation within thirty days after the date the member receives the written document described in division (C) of section 3961.04 of the Revised Code for the discount medical plan, the discount medical plan organization, within thirty days of the member giving notice of cancellation, shall fully refund any fees except for a nominal fee associated with enrollment costs that shall not exceed thirty dollars.
(C) A discount medical plan organization shall not charge or collect a periodic fee after the member has returned to the organization the member's discount medical plan card or given the organization notice of cancellation.
(D) Cancellation of membership in a discount medical plan occurs when the member gives notice of cancellation to the discount medical plan organization or marketer by delivering the notice by hand, depositing the notice in a mailbox if the notice is properly addressed to the discount medical plan organization or marketer and postage is prepaid, or sending an electronic message to the discount medical plan organization's or marketer's electronic message address.
(E) A discount medical plan organization shall make a pro rata reimbursement of all periodic fees charged to a member, less nominal fees associated with enrollment, if a discount medical plan organization cancels a member's membership for any reason other than the member's failure to pay fees.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3961 | Discount Medical Plans › Section 3961.09 | Adoption of Implementing Rules.

Effective:
March 23, 2007
Latest Legislation:
Senate Bill 5 - 126th General Assembly
The superintendent of insurance may adopt rules in accordance with Chapter 119. of the Revised Code for purposes of implementing sections 3961.01 to 3961.08 of the Revised Code.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3963 | Health Care Contracts › Section 3963.05 | Standard Provider Credentialing Application - Form.

Effective:
June 25, 2008
Latest Legislation:
House Bill 125 - 127th General Assembly
(A) The department of insurance shall prescribe the credentialing application form used by the council for affordable quality healthcare (CAQH) in electronic or paper format for physicians. The department of insurance also shall prepare the standard credentialing form for all other providers and shall make the standard credentialing form as simple, straightforward, and easy to use as possible, having due regard for those credentialing forms that are widely in use in the state by contracting entities and that best serve these goals.
(B) No contracting entity shall fail to use the applicable standard credentialing form described in division (A) of this section when initially credentialing or recredentialing providers in connection with policies, health care contracts, and agreements providing basic health care services, specialty health care services, or supplemental health care services.
(C) No contracting entity shall require a provider to provide any information in addition to the information required by the applicable standard credentialing form described in division (A) of this section in connection with policies, health care contracts, and agreements providing basic health care services, specialty health care services, or supplemental health care services.
(D) The credentialing process described in this section does not prohibit a contracting entity from limiting the scope of any participating provider's basic health care services, specialty health care services, or supplemental health care services.
(E) The requirement that the department of insurance prepare the standard credentialing form for all other providers does not include preparing the standard credentialing form for a hospital.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3963 | Health Care Contracts › Section 3963.07 | Contents of Remittance Notices.

Effective:
June 25, 2008
Latest Legislation:
House Bill 125 - 127th General Assembly
(A) All remittance notices sent by a payer, whether written or electronic, shall include both of the following:
(1) The name of the payer issuing the payment to the participating provider;
(2) The name of the contracting entity through which the payment rate and any discount are claimed, if the contracting entity is different from the payer.
(B) Division (A) of this section takes effect March 31, 2009.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3963 | Health Care Contracts › Section 3963.09 | Unfair and Deceptive Practices - Market Conduct Examination.

Effective:
June 25, 2008
Latest Legislation:
House Bill 125 - 127th General Assembly
(A) A series of violations of this chapter by any person regulated by the department of insurance under Title XVII or Title XXXIX of the Revised Code that, taken together, constitute a pattern or practice of violating this chapter may be defined as an unfair and deceptive insurance practice under sections 3901.19 to 3901.26 of the Revised Code.
(B) The superintendent of insurance may conduct a market conduct examination of any person regulated by the department of insurance under Title XVII or Title XXXIX of the Revised Code to determine whether any violation of this chapter has occurred. When conducting that type of examination, the superintendent of insurance may assess the costs of the examination against the person examined. The superintendent may enter into a consent agreement to impose any administrative assessment or fine for conduct discovered that may be a violation of this chapter. All costs, assessments, and fines collected under this section shall be deposited to the credit of the department of insurance operating fund.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3963 | Health Care Contracts › Section 3963.10 | Application of Chapter.

Effective:
June 25, 2008
Latest Legislation:
House Bill 125 - 127th General Assembly
This chapter does not apply with respect to any of the following:
(A) A contract or provider agreement between a provider and the state or federal government, a state agency, or federal agency for health care services provided through a program for medicaid or medicare;
(B) A contract for payments made to providers for rendering health care services to claimants pursuant to claims made under Chapter 4121., 4123., 4127., or 4131. of the Revised Code;
(C) An exclusive contract between a health insuring corporation and a single group of providers in a specific geographic area to provide or arrange for the provision of health care services.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3963 | Health Care Contracts › Section 3963.11 | Prohibited Conduct by Contracting Entities.

Effective:
September 29, 2011
Latest Legislation:
House Bill 153 - 129th General Assembly
(A) No contracting entity shall do any of the following:
(1) Offer to a provider a health care contract that includes a most favored nation clause;
(2) Enter into a health care contract with a provider that includes a most favored nation clause;
(3) Amend or renew an existing health care contract previously entered into with a provider so that the contract as amended or renewed adds or continues to include a most favored nation clause.
(B) As used in this section:
(1) "Contracting entity," "health care contract," "health care services," "participating provider," and "provider" have the same meanings as in section 3963.01 of the Revised Code.
(2) "Most favored nation clause" means a provision in a health care contract that does any of the following:
(a) Prohibits, or grants a contracting entity an option to prohibit, the participating provider from contracting with another contracting entity to provide health care services at a lower price than the payment specified in the contract;
(b) Requires, or grants a contracting entity an option to require, the participating provider to accept a lower payment in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;
(c) Requires, or grants a contracting entity an option to require, termination or renegotiation of the existing health care contract in the event the participating provider agrees to provide health care services to any other contracting entity at a lower price;
(d) Requires the participating provider to disclose the participating provider's contractual reimbursement rates with other contracting entities.
2023 Ohio Revised Code › Title 39 | Insurance › Chapter 3964 | Captive Insurance Companies › Section 3964.01 | Definitions.

Effective:
September 17, 2014
Latest Legislation:
House Bill 117 - 130th General Assembly
As used in this chapter:
(A) "Affiliated company" means any company in the same corporate system as a parent, or a member organization by virtue of common ownership, control, operation, or management.
(B) "Captive insurance company" means any insurer that insures only the risks of its parent or affiliated companies of its parent. "Captive insurance company" includes any protected cell captive insurance company formed or licensed under the provisions of this chapter.
(C) "Department" means the department of insurance.
(D) "Parent" means a corporation, limited liability company, partnership, other entity, or individual that directly or indirectly owns, controls, or holds, with power to vote, more than fifty per cent of either of the following:
(1) Securities of a captive insurance company, organized as a stock corporation;
(2) Membership interests of a captive insurance company organized as a nonprofit corporation or a limited liability company.
(E) "Protected cell captive insurance company" means a captive insurance company organized pursuant to sections 3964.17 to 3964.1710 of the Revised Code.
(F) "Qualified actuary" means an individual who is both of the following:
(1) A member of the American academy of actuaries;
(2) Qualified to provide such certifications as described in the United States qualifications standards promulgated by the American academy of actuaries pursuant to the code of professional conduct adopted by the American academy of actuaries, the society of actuaries, the American society of pension professionals and actuaries, the casualty actuarial society, and the conference of consulting actuaries.
(G) "Special purpose financial captive insurance company" means a captive insurance company organized pursuant to sections 3964.19 to 3964.194 of the Revised Code.
(H) "Superintendent" means the superintendent of the department of insurance.