reglab/statecodes huggingface dataset:
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-6 - Life Insurance › Section 3901-6-13 - Suitability in annuity transactions

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
(1)
									The purpose of
			 this rule is to require insurance agents, as defined in this rule, to act in
			 the best interest of the consumer when making a recommendation of an annuity
			 and to require insurers, including fraternal benefit societies, to establish
			 and maintain a system to supervise recommendations so that the insurance needs
			 and financial objectives of consumers, at the time of the transaction, are
			 effectively addressed.
(2)
									This rule will bring Ohio law into compliance with the
			 Dodd-Frank Wall Street Reform and Consumer Protection Act of 2010, Public Law
			 Number 111-203, 111th Cong., 2d sess. (July 21, 2010).
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-6 - Life Insurance › Section 3901-6-15 - Preneed life insurance minimum standards for determining reserve liabilities and nonforfeiture values

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to establish for preneed insurance
				products minimum mortality standards for reserves and nonforfeiture values, and
				to require the use of the "1980 Commissioners Standard Ordinary (CSO) Life
				Valuation Mortality Table" for use in determining the minimum standard of
				valuation of reserves and the minimum standard nonforfeiture values for preneed
				insurance products.
(B)
			 Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under sections
				3901.041,
				3903.72,
				3903.721, and
				3915.071 of the Revised Code and
				rule 3901-6-10 of the Administrative
				Code (valuation of life insurance policies).
(C) Scope
This rule applies to preneed insurance contracts, as defined in
				paragraph (D)(3) of this rule.
(D) Definitions
(1) The term "2001 CSO Mortality Table" means
			 that mortality table, consisting of separate rates of mortality for male and
			 female lives, developed by the American academy of actuaries CSO task force
			 from the "Valuation Basic Mortality Table" developed by the society of
			 actuaries individual life insurance valuation mortality task force, and adopted
			 by the national association of insurance commissioners (NAIC) in December 2002.
			 The "2001 CSO Mortality Table" is included in the "Proceedings of the NAIC (2nd
			 Quarter 2002)." Unless the context indicates otherwise, the "2001 CSO Mortality
			 Table" includes both the ultimate form of that table and the select and
			 ultimate form of that table and includes both the smoker and nonsmoker
			 mortality tables and the composite mortality tables. It also includes both the
			 age-nearest-birthday and age-last-birthday bases of the mortality
			 tables.
(2) The term "Ultimate 1980
			 CSO" means the "Commissioners' 1980 Standard Ordinary Life Valuation Mortality
			 Tables (1980 CSO)" without ten-year selection factors, incorporated into the
			 1980 amendments to the NAIC Standard Valuation Law approved in December
			 1983.
(3) For the purposes of this
			 rule, a preneed insurance contract is any life insurance policy or certificate
			 that will be marketed and sold solely to fund preneed funeral contracts, as
			 defined by division (T) of section
			 4717.01 of the Revised Code.
			  The status of the policy or contract as preneed
			 insurance is determined at the time of issue in accordance with the policy form
			 filing, pursuant to section
			 3915.14 of the Revised
			 Code.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-6 - Life Insurance › Section 3901-6-16 - Annuity nonforfeiture product standards

Current through all regulations passed and filed through July 1, 2024
(A)
								 Purpose
The purpose of this rule is to amplify
				section 3915.073 of the Revised Code and
				to define the maturity date used for the purpose of calculating nonforfeiture
				values for annuity contracts filed in this state and to establish rules
				relative to the calculation of nonforfeiture values for certain product
				features and designs used in annuity contracts issued in this state.
(B)
								 Authority
This rule is promulgated pursuant to
				the authority vested in the superintendent under sections
				3901.041 and
				3901.21 of the Revised
				Code.
(C)
								 Scope
This rule applies to all annuity
				contracts issued ninety days after the effective date of this rule and not
				specifically excluded in division (B) of section
				3915.073 of the Revised
				Code.
(D)
								 No private cause of action
Nothing herein shall be construed to
				create or imply a private cause of action for a violation of this rule.
(E)
								 Definitions
As used in this rule:
(1)
									 "Prospective
			 test" is the nonforfeiture test, included in the filed actuarial memorandum,
			 used to demonstrate compliance with division (F) of section
			 3915.073 of the Revised
			 Code.
(2)
									 "Retrospective test" is the nonforfeiture test,
			 included in the filed actuarial memorandum, used to demonstrate compliance with
			 division (D) of section
			 3915.073 of the Revised
			 Code.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-7 - Title Insurance Agents › Section 3901-7-01 - Annual review of title insurance agent escrow accounts

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to establish the criteria for the
				annual independent review of title insurance agents' escrow, settlement,
				closing, and security deposit depository institution accounts.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under sections
				3901.041 and
				3953.33 of the Revised
				Code.
(C) Definitions
As used in this rule:
(1) "Agent" means either an individual title
			 insurance agent or a business entity title insurance agent licensed by the Ohio
			 department of insurance.
(2)
			 "Escrow account" includes any escrow, settlement, closing, or security deposit
			 account owned or maintained by the title agent being reviewed.
(3) "IOTA" account means "Interest on Trust
			 Account", which is an escrow account established and maintained pursuant to
			 section 3953.231 of the Revised
			 Code.
(4) "Person" means any
			 natural person or any business entity as defined in section
			 3905.01 of the Revised
			 Code.
(5) "Transaction" means the
			 handling of client or third party funds related to any purchase or sale of real
			 property, or any finance or refinance secured by a mortgage on real
			 property.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-7 - Title Insurance Agents › Section 3901-7-02 - Title insurance agents maintenance of surety bond and errors and omissions coverage

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to set forth the requirements
				regarding the surety bond and errors and omissions coverage to be maintained by
				title insurance agents or agencies under conditions specified in section
				3953.23 of the Revised Code.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under sections
				3901.041 and
				3953.23 of the Revised Code.
(C) Surety bond
All title insurance agents or agencies that handle escrows in
				real property transactions not involving the issuance of title insurance shall
				have a surety bond in place that protects all parties to such transactions
				against theft, misappropriation, fraud, or any other failure to properly
				disburse settlement, closing, or escrow funds.
(1) The surety bond shall be on a form
			 approved by the superintendent and shall provide coverage in the minimum amount
			 of one hundred fifty thousand dollars.
(2) The surety bond shall be kept in full
			 force and effect as a condition precedent to the title agent's authority to
			 transact escrow, settlement, or closing functions for real estate transactions
			 not involving the issuance of title insurance and the title insurance agent
			 shall supply the superintendent with satisfactory evidence thereof upon
			 request.
(3)
(a)
										 Licensed agents
			 who are employees of title insurance companies authorized to do business in
			 this state and direct operations of title insurance companies authorized to do
			 business in this state are not required to maintain separate surety bond
			 coverage.
(b)
										 Title insurance companies authorized to do business in
			 this state may self-insure wholly-owned subsidiary title agencies and employees
			 of those agencies who are licensed as title insurance agents for the purpose of
			 surety bond coverage.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-7 - Title Insurance Agents › Section 3901-7-03 - Title insurance agents notice to mortgagors

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to set forth the requirements
				regarding the notice to be provided to mortgagors by title insurance agents
				concerning title insurance coverage under conditions specified in section
				3953.30 of the Revised Code.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under sections
				3901.041 and
				3953.30 of the Revised Code.
(C) Notice
A title insurance agent issuing a lender's title insurance
				policy in conjunction with a residential mortgage loan made simultaneously with
				the purchase of all or part of the real property securing the loan, where no
				owner's title insurance policy has been requested, shall provide the notice set
				forth in the appendix to this rule to the mortgagor at the time the commitment
				is prepared.
(D) Notice to
			 be maintained
The title insurance agent required to provide the notice
				described in this rule shall maintain a copy of the notice, signed by the
				mortgagor, on file for at least ten years after the effective date of the
				lender's title insurance policy.
(E) Severability
If any paragraph, term or provision of this rule or the
				application thereof to any person or situation be adjudged invalid for any
				reason such invalidity shall not affect, impair or invalidate any other
				section, term or provision of this rule or the application thereof which can be
				given effect without the invalid provision or application and to this end the
				provisions of this rule are declared to be severable.
Click to
				view Appendix
Five Year Review (FYR) Dates:
				08/19/2016 and
				08/19/2021
Promulgated
				Under: 119.03
Statutory
				Authority: 3901.041,
				3953.30
Rule
				Amplifies: 3953.30
Prior
				Effective Dates: 1/1/2007
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-7 - Title Insurance Agents › Section 3901-7-04 - Title insurance controlled business arrangements

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to establish ownership and
				licensing standards for title insurance agents and agencies in accordance with
				division (B) of section
				3953.21
				of the Revised Code, which prohibits certain persons from acting as agents for
				a title insurance company.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under section
				3901.041
				of the Revised Code.
(C)
			 Definitions
As used in this rule:
(1) "Beneficial ownership" means the
			 effective ownership of any interest in a title insurance agency or the right to
			 control an ownership interest even though legal ownership may be held in
			 another person's name.
(2)
			 "Control," including "controlling," "controlled by," and "under common control
			 with" means the possession, direct or indirect, of the power to direct or cause
			 the direction of the management and policies of a person, whether through the
			 ownership of voting securities, by contract other than a commercial contract
			 for goods or non-management services, or otherwise. Control shall be presumed
			 to exist if any person, directly or indirectly, owns, controls, holds with the
			 power to vote, or holds proxies representing fifty per cent or more of the
			 voting securities or interests of any other person. Control shall also be
			 presumed to exist between a natural person and an immediate family member.
			 These presumptions may be rebutted by showing that control does not exist in
			 fact. The superintendent of insurance may determine that control exists if the
			 facts support such a determination notwithstanding the absence of a presumption
			 to that effect.
(3) "Immediate
			 family member" includes a person's father, mother, stepfather, stepmother,
			 brother, sister, stepbrother, stepsister, son, daughter, stepson, stepdaughter,
			 grandparent, grandson, granddaughter, father-in-law, mother-in-law,
			 brother-in-law, sister-in-law, son-in-law, daughter-in-law, the spouse of any
			 of the foregoing, and the person's spouse.
(4) "Person" means any natural person or any
			 business entity as defined in division 
									(P) of section
			 3905.01
			 of the Revised Code.
(5)
			 "Prohibited person" means a person prohibited from acting as an agent for a
			 title insurance company pursuant to division (B) of section
			 3953.21
			 of the Revised Code, and includes builders and developers.
(6) "RESPA" means the Real Estate Settlement
			 Procedures Act,
			 12 U.S.C.
			 2601 et seq., as amended, and all rules,
			 regulations and interpretations issued under RESPA, as amended, including but
			 not limited to 24 C.F.R. Part 3500 and the Statement of Policy 1996-2 Regarding
			 Sham Controlled Business Arrangements found at 61 Fed. Reg. 29258 et
			 seq.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-01 - Coordination of benefits

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to:
(1) Permit plans to include a coordination of
			 benefits "(COB)" provision;
(2)
			 Provide the authority for the orderly transfer of information needed to pay
			 claims promptly;
(3) Eliminate
			 duplication of benefits by permitting a plan to reduce benefits paid when,
			 pursuant to this rule, it is not required to pay its benefits first;
(4) Reduce claim payment delays;
			 and
(5) Further define the "COB"
			 statute.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-02 - Provider discounts

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule
				
									is to
				set the requirements that third party payers shall follow if the third
				party payer receives any discount from billed charges from a health care
				provider.
(B) Authority
This rule is 
									promulgated pursuant to the authority vested in
				the superintendent of insurance under 
									sections
				3901.041 and 3901.19 to 3901.22 of the Revised
				Code.
(C)
			 Definitions
(1) "Discount" means any
			 negotiated reduction or variation from the schedule of billed charges
			 (including capitation) that a health care provider otherwise would require a
			 patient and/or the patient's third party payer to pay to that health care
			 provider.
(2) "Billed charges"
			 means the non-discounted schedule of charges for services that the health care
			 provider would use to invoice a patient for services rendered.
(3) "Third party payer" means any of the
			 following:
(a) An insurance company;
(b) A preferred provider
			 organization;
(c) A labor
			 organization;
(d) An
			 employer;
(e) An administrator
			 subject to sections 3959.01 to
			 3959.16 of the Revised
			 Code;
(f) A multiple employer
			 welfare arrangement subject to sections
			 1739.01 to
			 1739.99 of the Revised
			 Code.
(g) Any other person that is
			 obligated pursuant to a benefits contract to reimburse for covered health care
			 services to beneficiaries under such contract, except that "third party payer"
			 does not include a health insuring corporation licensed pursuant to Chapter
			 1751. of the Revised Code.
(4) "Reasonable cash value" means the amount
			 the third party payer would reimburse the patient or health care provider in
			 the absence of a capitation agreement.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-04 - Accreditation of independent review organizations

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to govern the accreditation and
				operation of independent review organizations.
(B) Authority
This rule is issued pursuant to the authority vested in the
				superintendent under sections 
									3901.041,
				3901.19 to
				3901.26 and
				3922.22 of the Revised
				Code.
(C) Applicability and
			 scope
Except as otherwise provided, this rule shall apply to:
(1) Health plan issuers as defined in section
			 3922.01 of the Revised Code;
			 and
(2) Independent review
			 organizations as defined in section
			 3922.01 of the Revised Code
			 seeking accreditation or accredited by the superintendent to conduct external
			 reviews on behalf of health plan issuers on or after January 1,
			 2012.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-05 - Regulation of third party administrators

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to establish regulatory standards
				for third party administrators.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under sections
				3901.041,
				3959.01 to
				3959.16, and
				3959.99 of the Revised
				Code.
(C) Definitions. As
			 used in this rule:
(1) "Third party
			 administrator" means any person that adjusts or settles claims in connection
			 with life, dental, vision, health, prescription drugs, or disability insurance
			 plans, self-insurance programs or other benefit plans for a sponsor of a plan
			 if either the sponsor or the plan is domiciled in this state or has its
			 principal headquarters or principal administrative offices in this state.
			 "Third party administrator" includes a pharmacy benefit manager.
"Third party administrator" does not include any of the
				following:
(a) An insurance agent or
			 solicitor licensed in this state whose activities are limited exclusively to
			 the sale of insurance and who does not provide any administrative
			 services;
(b) Any person who
			 administers or operates exclusively the workers' compensation program of an
			 employer who has been granted self-insurance status pursuant to section
			 4123.35 of the Revised
			 Code;
(c) Any person who
			 administers pension plans for the benefit of its own members or employees or
			 administers pension plans for the benefit of the members or employees of any
			 other person;
(d) Any person that
			 administers an insured plan, a self-insurance program, or other benefit plans
			 in connection with life, vision, dental, health, or disability benefits
			 exclusively for the person's own members or employees; and
(e) Any health insuring corporation organized
			 under Chapter 1751. of the Revised Code, or an insurance company that is
			 authorized to write life or sickness and accident insurance in this
			 state.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-06 - HIV model consent form

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
The purpose of this rule is to
				establish the form and content of the written consent form an insurer uses in
				order to obtain an applicant's consent to an HIV test.
(B)
								Authority
This rule is promulgated pursuant to
				the authority vested in the superintendent under section
				3901.041 of the Revised
				Code.
(C)
								Applicability
This rule applies to all insurers
				permitted by Chapter 3901. of the Revised Code to require applicants for life
				or sickness and accident insurance coverage to submit to an HIV
				test.
(D)
								Definitions
(1)
									"AIDS" means the illness designated as acquired immune
			 deficiency syndrome.
(2)
									"HIV" means the human immunodeficiency virus identified
			 as the causative agent of AIDS.
(3)
									"HIV test" means
			 any test for the antibody or antigen to HIV that has been approved by the
			 director of health under division (B) of section
			 3701.241 of the Revised
			 Code.
(4)
									"Insurer" means any person authorized to engage in the
			 business of life or sickness and accident insurance under Title XXXIX of the
			 Revised Code or any person or governmental entity providing health services
			 coverage for individuals on a self-insurance basis.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-07 - Advertisement of sickness and accident insurance

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of
				this rule is to assure truthful and adequate disclosure of all material and
				relevant information in the advertising of sickness and accident insurance.
				This purpose is intended to be accomplished by the establishment of, and
				adherence to, certain minimum standards and guidelines of conduct in the
				advertising of sickness and accident insurance in a manner which prevents
				unfair competition among insurers and is conducive to the accurate presentation
				and description for the insurance buying public of a policy of such insurance
				offered through various advertising media. Section
				3923.16 of the Revised Code
				prohibits the use of any advertising copy, advertising plan, or plan of
				solicitation in connection with the solicitation of sickness or accident
				insurance which is materially misleading or deceptive.
(B)
								Authority
This rule is promulgated pursuant to
				the authority vested in the superintendent under section
				3901.041 of the Revised
				Code.
(C) Applicability
(1) This rule 
									applies
			 to any sickness and accident insurance "advertisement," as that term is
			 hereinafter defined, intended for presentation, distribution or dissemination
			 in this state when such presentation, distribution or dissemination is made
			 either directly or indirectly by or on behalf of an insurer, agent, broker or
			 solicitor as those terms are defined in the Revised Code and this
			 rule.
(2) Every insurer shall
			 establish and at all times maintain a system of control over the content, form
			 and method of dissemination of all advertisements of its policies. All such
			 advertisements, regardless of by whom written, created, designed or presented,
			 
									are
			 the responsibility of the insurer whose policies are so advertised.
(3) Advertisements that are reproduced in
			 quantity shall be identified by form numbers or other identifying means. The
			 identification shall be sufficient to distinguish an advertisement from any
			 other advertising materials, policies, applications or other materials used by
			 the insurer.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-08 - Medicare supplement

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to provide for the reasonable
				standardization of coverage and simplification of terms and benefits of
				medicare supplement policies; to facilitate public understanding and comparison
				of such policies; to eliminate provisions contained in such policies which may
				be misleading or confusing in connection with the purchase of such policies or
				with the settlement of claims; and to provide for full disclosures in the sale
				of sickness and accident insurance coverage to persons eligible for
				medicare.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under sections
				3901.041,
				3923.33 and
				3923.331 to
				3923.339 of the Revised
				Code.
(C) Applicability and
			 scope
(1) Except as otherwise specifically
			 provided in paragraphs (G), (P), (Q), (T), and (Y) of this rule, this rule
			 
									applies to:
(a) All
			 medicare supplement policies, delivered or issued for delivery in this state on
			 or after the effective date of this rule; and
(b) All certificates issued under group
			 medicare supplement policies which certificates have been delivered or issued
			 for delivery in this state on or after the effective date of this
			 rule.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-09 - Solicitation and sale of medicare supplemental accident and health policies

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to safeguard the interests of
				medicare-eligible persons in the solicitation and sale of any type of medicare
				supplemental sickness and accident health insurance 
									policy by
				providing for the regulation of the solicitation and sale of medicare
				supplemental accident and health insurance policies; and to assure that
				medicare-eligible persons are not subjected to unfair or deceptive acts or
				practices in the solicitation and sale of medicare supplemental accident and
				health insurance policies by defining additional unfair or deceptive acts or
				practices in this rule.
(B)
			 Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under section
				3901.041 of the Revised Code,
				providing that the superintendent of insurance shall adopt, amend and rescind
				rules and make adjudications necessary to discharge the superintendent's duties
				and exercise the superintendent's powers under Title 39 of the Revised Code;
				section 3923.332 of the Revised Code,
				providing that the superintendent shall adopt reasonable rules to establish
				minimum standards for advertising and marketing practices for medicare
				supplemental policies and certificates; and section
				3901.21 of the Revised Code,
				providing that the enumeration in sections
				3901.19 to
				3901.26 of the Revised
				Codeof specific unfair or deceptive acts
				or practices in the business of insurance is not exclusive or restrictive or
				intended to limit the powers of the superintendent of insurance to adopt rules
				to implement said section, or to take action under other sections of the
				Revised Code.
(C)
			 Definitions
(1) "Medicare-eligible person"
			 means any person eligible for either medicare part A or medicare part B,
			 pursuant to Title XVIII
									of the federal Social Security Act (
			 42 U.S.C.
			 1395 et seq.).
(2) "Medicare program" refers to the benefits
			 available to medicare-eligible persons, pursuant to Title XVIII of the Social
			 Security Act, codified in Title XVIII of the federal Social Security
			 Act (
			 42 U.S.C.
			 1395 et seq.).
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-10 - Notice of public hearing on rates for individual sickness and accident insurance

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of
				this rule is to provide specific requirements for the dissemination of
				information concerning  a public
				hearing scheduled by the superintendent of insurance
				pursuant to section 3923.021 of the Revised
				Code.
(B)
								 Authority
This rule is promulgated pursuant to
				the authority vested in the superintendent under section
				3901.041 of the Revised
				Code.
(C) Definitions
(1)
			 "Notice" means a statement which sets forth at least the following:
(a) The name and address of the
			 insurer;
(b) The date, time and
			 place of the scheduled hearing;
(c)
			 The purpose of the hearing;
(d) A
			 statement that identifies the policies, endorsements, and/or riders affected by
			 the filing and hearing;
(e) A
			 statement that members of the public are entitled to testify at the public
			 hearing.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-11 - Unfair health claim practices

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to define certain additional unfair
				trade practices and to set forth minimum standards in connection with the
				investigation and disposition of health claims arising under policies,
				certificates or contracts issued pursuant to Ohio's insurance statutes, rules
				and regulations under Titles XVII and XXXIX of the Revised Code.
				
									Violation of this rule does not create or imply a
				private cause of action .
(B)
			 Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under section
				3901.041 of the Revised
				Code.
Sections
				3901.20 and
				3901.21 of the Revised Code,
				respectively, prohibit unfair or deceptive practices in the business of
				insurance and define certain acts or practices as unfair or deceptive. Section
				3901.21 of the Revised Code also
				provides that the enumeration of specific unfair or deceptive acts or practices
				in the business of insurance is not exclusive or restrictive or intended to
				limit the powers of the superintendent of insurance to adopt rules to implement
				that section.
Section 3901.3813 of the Revised Code permits the
				superintendent to adopt rules as the superintendent considers necessary to
				carry out the purposes of section
				3901.38 and sections
				3901.381 to
				3901.3812 of the Revised
				Code.
(C) Definitions
(1) "Claim" means any request submitted to a
			 third-party payer for benefits or proceeds under a benefit plan or contract on
			 a standardized health claim form as described in rule
			 3901-8-03 of the Administrative
			 Code.
(2) "Coordinated Care" means
			 the management of health care services by a third-party payer for a
			 beneficiary. Examples include, but are not limited to, provider selection or
			 referral, preadmission certification, length of stay determination and second
			 surgical opinions.
(3) "Day" means
			 calendar day. However, when the last day of a time limit stated in this rule
			 falls on a Saturday, Sunday or state or federal holiday, the time limit is
			 extended to the next immediate following day that is not a Saturday, Sunday or
			 holiday.
(4) "Deny or Denial" means
			 a refusal to pay any portion of a claim. The application of contractual co-pays
			 and deductibles are not considered a denial of a claim.
(5) "Documentation" includes, but is not
			 limited to, all supporting documentation as defined in division (B)(2) of
			 section 3901.381 of the Revised Code and
			 any records of communications or activities, notes, work papers, claim forms,
			 bills and explanation of benefit forms relative to a claim, including the
			 electronic transmission of the data contained in such items.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-16 - Required provider network disclosures for consumers

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to implement and interpret
				applicable statutes including sections
				3901.21 and
				3923.16 of the Revised Code by
				further defining unfair trade practices and setting forth minimum standards for
				the adequate disclosure of any limitations or restrictions on access to
				providers/facilities to enrollees and to potential enrollees prior to
				enrollment in a particular health plan.
(B) Authority
This rule is promulgated pursuant to the authority vested in
				the superintendent under section
				3901.041 of the Revised Code,
				general rule making authority; and section
				3901.21 of the Revised Code, the
				unfair and deceptive acts statute.
(C) Definitions
(1) "Enrollee" for the purpose of this rule
			 
									means any natural person who is entitled or
			 potentially entitled to receive health care benefits provided by a health plan
			 issuer.
(2) "Health benefit plan"
			 for the purpose of this rule 
									has the same meaning as set forth in division (L)
			 of section 3922.01 of the Revised
			 Code.
(3) "Health plan issuer" or
			 "issuer" for the purpose of this rule 
									means an entity subject to the
			 insurance laws and rules of this state, or subject to the jurisdiction of the
			 superintendent of insurance, that contracts, or offers to contract, to provide,
			 deliver, arrange for, pay for, or reimburse any of the costs of health care
			 services under a health benefit plan, including a sickness and accident
			 insurance company; a health insuring corporation; a fraternal benefit society;
			 a self-funded multiple employer welfare arrangement; or a nonfederal,
			 government health plan. "Health plan issuer" includes a third party
			 administrator licensed under Chapter 3959. of the Revised Code to the extent
			 that the benefits that such an entity is contracted to administer under a
			 health benefit plan are subject to the insurance laws and rules of this state
			 or subject to the jurisdiction of the superintendent. "Health plan issuer" also
			 includes a contracting entity as defined under Chapter 3963. of the Revised
			 Code to the extent that the contracted for health care services are provided
			 under a health benefit plan subject to the insurance laws and rules of this
			 state or subject to the jurisdiction of the superintendent.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-8 - Health Insurance › Section 3901-8-17 - Reimbursement for unanticipated out-of-network care

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
The purpose of this rule is to
				implement sections
				3902.50
				to
				3902.54
				of the Revised Code.
(B)
								Authority
This rule is promulgated pursuant to
				the authority vested in the superintendent under sections
				3902.50
				to
				3902.54
				of the Revised Code.
(C)
								Scope
This rule applies to all unanticipated
				out-of-network care as defined in section
				3902.50
				of the Revised Code.
(D)
								No private cause
			 of action
Nothing herein shall be construed to
				create or imply a private cause of action for a violation of this
				rule.
(E)
								Definitions
As used in this rule:
(1)
									"Ambulance" has
			 the same meaning as in section
			 4765.01
			 of the Revised Code.
(2)
									"Clinical laboratory services" has the same meaning as
			 in section
			 4731.65
			 of the Revised Code.
(3)
									"Cost sharing" means the cost to a covered person under
			 a health benefit plan according to any copayment, coinsurance, deductible, or
			 other out-of-pocket expense requirement.
(4)
									"Covered person,"
			 "health benefit plan," "health care services," and "health plan issuer" have
			 the same meanings as in section
			 3922.01 of the
			 Revised Code.
(5)
									"Emergency facility" has the same meaning as in section
			 3701.74
			 of the Revised Code.
(6)
									"Emergency services" means all of the following as
			 described in
			 42
			 U.S.C. 1395dd:
(a)
										Medical screening
			 examinations undertaken to determine whether an emergency medical condition
			 exists;
(b)
										Treatment necessary to stabilize an emergency medical
			 condition; and
(c)
										Appropriate transfers undertaken prior to an emergency
			 medical condition being stabilized.
(7)
									"Unanticipated
			 out-of-network care" means health care services, including clinical laboratory
			 services, that are covered under a health benefit plan and that are provided by
			 an out-of- network provider when either of the following conditions
			 applies:
(a)
										The covered person did not have the ability to request such
			 services from an in-network provider.
Clinical laboratory services provided
				by an out-of-network provider, but that are ordered by an in-network provider,
				shall be considered to have met the condition prescribed in paragraph (E)(7)(a)
				of this rule unless the provider rendering the laboratory services discloses
				its network status in writing to the covered person before the services are
				provided.
(b)
										The services provided were emergency
			 services.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-9 - Viatical Settlement Providers and Stranger-originated Life Insurance › Section 3901-9-01 - Viatical settlement providers

Current through all regulations passed and filed through July 1, 2024
(A)
								 Purpose
The purpose of this rule is to provide
				standards for applicants applying for initial licensure as a viatical
				settlement provider in this state or renewal of a previously-issued license.
				This rule also provides form filing requirements and fees for licenses,
				renewals, and form approvals.
(B)
								 Authority
This rule is promulgated under the
				authority granted the superintendent of insurance pursuant to sections
				3901.011,
				3901.041,
				3901.19 to
				3901.26,
				3916.05, and
				3916.20 of the Revised
				Code.
(C)
								 Applicability and scope
This rule applies to all persons
				applying for or renewing a license or who are currently licensed as a viatical
				settlement provider in this state.
(D)
								 Definitions
The definitions set forth in Chapter
				3916. of the Revised Code are incorporated by reference herein. The following
				are terms used in this rule:
(1)
									 "Applicant"
			 means a person who is applying to be licensed or applying to renew a license as
			 a viatical settlement provider.
(2)
									 "Person" means
			 an individual or a business entity.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-9 - Viatical Settlement Providers and Stranger-originated Life Insurance › Section 3901-9-03 - Viatical settlement broker continuing education

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
The purpose of this rule is to establish viatical settlement
				education (VSE) requirements, criteria, standards and procedures and fees for
				VSE providers, VSE courses and licensed viatical settlement brokers pursuant to
				Chapter 3916. of the Revised Code.
(B) Authority
This rule is issued pursuant to the authority vested in the
				superintendent under sections 
										3901.011,
				3901.041,
									3901.19
				to
				3901.26,
				3916.03,
				and
				3916.20 of the Revised
				Code.
(C) Application and
			 scope
This rule applies to all persons applying to provide,
				providing, or enrolled in a viatical settlement education course or program to
				be offered pursuant to the requirements of division (G) of section
				3916.03
				of the Revised Code.
(D)
			 Definitions
(1) "Authorized provider official"
			 is the person designated by a viatical settlement education provider as the
			 individual responsible for the conduct of the provider's employees, monitors
			 and instructors of the continuing viatical settlement broker education
			 course.
(2) "Compliance period"
			 means the period of time in which a viatical settlement individual broker must
			 complete the required continuing education (CE) credits pursuant to division
			 (G) of section
			 3916.03
			 of the Revised Code.
(3) "Provider"
			 or "viatical settlement education provider (VSE provider)" is any person or
			 entity who is permitted to offer viatical settlement broker education courses
			 pursuant to division (G) of section
			 3916.03
			 of the Revised Code.
(4) "Viatical
			 Settlement Broker" or "licensee" means an individual or business entity that
			 has applied for and been granted a viatical settlement broker license in this
			 state.
(5) "Viatical settlement
			 education" or VSE means the viatical settlement education required by division
			 (G) of section
			 3916.03
			 of the Revised Code for individuals licensed as a viatical settlement broker
			 and this rule.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-9 - Viatical Settlement Providers and Stranger-originated Life Insurance › Section 3901-9-04 - Insurance company questions on life insurance applications to identify and prevent stranger originated life insurance

Current through all regulations passed and filed through July 1, 2024
(A)
								 Purpose
The purpose of this rule is to provide
				guidance to life insurance companies regarding the types of questions that must
				be included on life insurance applications pursuant to division (B) of section
				3916.05 of the Revised Code to
				identify and prevent stranger-originated life insurance (STOLI).
(B)
								
			 Authority
This rule is adopted pursuant to
				sections 3901.04,
				3901.041,
				3916.05 and
				3916.20 of the Revised
				Code.
(C)
								 Applicability and scope
This rule applies to all insurers
				engaged in the business of insurance in this state that issue life insurance
				policies.
(D)
								 Definitions
(1)
									 "Life insurance
			 applications" mean all applications for life insurance marketed, solicited,
			 sold, or issued in this state except for the following:
(a)
										 Applications for
			 credit life insurance;
(b)
										 Applications for life insurance policies to be owned
			 by a qualified retirement plan;
(c)
										 Applications for
			 term life insurance.
(d)
										 Applications for group insurance other than the
			 application submitted for the master group contract;
(e)
										 Applications
			 used in worksite marketing and direct-response solicitations.
(f)
										 Applications for
			 policies with a death benefit not exceeding fifty thousand dollars;
(g)
										 An
			 application to replace a policy when the application is to be submitted to the
			 same insurer that issued the existing policy or contract, so long as the
			 replacement policy's death benefit does not exceed fifty thousand
			 dollars;
(h)
										 An application for reinstatement of a previously
			 issued policy, so long as the reinstated policy's death benefit does not exceed
			 fifty thousand dollars;
(i)
										 An application to make changes to an in-force policy,
			 so long as the in-force policy's death benefit does not exceed fifty thousand
			 dollars.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-11 - Captive Insurance Companies › Section 3901-11-01 - Captive insurance company application

Current through all regulations passed and filed through July 1, 2024
(A)
								 Purpose
The purpose of this rule is to
				establish the information to be filed by an applicant for authority to form and
				license an Ohio domiciled captive insurance company pursuant to section
				3964.03 of the Revised
				Code.
(B)
								 Authority
This rule is promulgated pursuant to
				the authority vested in the superintendent under section
				3964.21 of the Revised
				Code.
(C)
								 Form of application
The superintendent of insurance shall
				post on the department of insurance website the forms to be used in applying
				for a license as an Ohio domiciled captive insurance
				company.
(D)
								 Information to be provided
In addition to the information
				required to be filed pursuant to division (D) of section
				3964.03 of the Revised Code, an
				applicant for a license as a captive insurance company shall complete form
				INS7020 made available on the department website, and provide:
(1)
									 A one or two
			 page executive summary of the captive insurance company's plan of
			 operation;
(2)
									 A plan of operation;
(3)
									 An investment
			 policy adopted by the board of directors;
(4)
									 A detailed
			 description of the coverages, deductibles, coverage limits, proposed rates or
			 rating plans, documentation from a qualified actuary that demonstrates the
			 actuarial soundness of the proposed rates or rating plans, for each insurance
			 company that offers direct insurance to its parent;
(5)
									 The place and
			 date of the Ohio meeting of its board of directors;
(6)
									 The Ohio address
			 of the captive insurance company's place of business;
(7)
									 The Ohio
			 residential address of the captive manager of the captive insurance
			 company;
(8)
									 The name and Ohio address of the captive insurance
			 company's agent for service of process;
(9)
									 Biographical
			 affidavits for all captive insurance company's officers, directors and captive
			 managers on forms provided by the superintendent of insurance, and third party
			 verification of biographical affidavits by an approved firm;
			 and
(10)
									 Any other information requested by the superintendent
			 of insurance.
Ohio Administrative Code › Title 3901 - Department of Insurance › Chapter 3901-11 - Captive Insurance Companies › Section 3901-11-02 - Additional capital and surplus required

Current through all regulations passed and filed through July 1, 2024
(A)
								 Purpose
The purpose of this rule is to
				establish the procedure for the superintendent of insurance to require
				additional capital and surplus of a captive insurance company pursuant to
				section 3964.05 of the Revised
				Code.
(B)
								 Authority
This rule is promulgated pursuant to
				the authority vested in the superintendent under section
				3964.21 of the Revised
				Code.
(C)
								 Basis of determination
(1)
									 In determining whether to require a
			 captive insurance company to increase its capital and surplus, the
			 superintendent of insurance shall take into consideration the following:
(a)
										 The type of
			 risks insured by the captive insurance company;
(b)
										 The volume of
			 coverage being written by the captive insurance company; and
(c)
										 The general
			 business environment and economic conditions.