This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and
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Rule |
Rule 3901-1-01 | Public notice by publication.
Effective:
November 10, 2014
(A) Purpose The purpose of this rule provides for the giving of proper notice by publication for various sections of Chapter 1731., 1739., 1751., or 1761. or Title XXXIX of the Revised Code, or as additionally determined by the superintendent of insurance for promulgation to the public of such insurance matters as are of widespread public interest and which do not set forth with particularity the means, content and frequency of notice nor come under the notice requirements of Chapter 119. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code. (C) Other public notice by superintendent of insurance Whenever Chapter 1731., 1739., 1751., or 1761. or Title XXXIX of the Revised Code, or as additionally determined by the superintendent of insurance require public notice to be given by the superintendent of insurance, and where the method and content of notice are not set forth with particularity, and do not fall within the notice requirements of Chapter 119. Such notice may be given by publication in a newspaper of general circulation of not less than ten thousand in Cuyahoga, Franklin, Hamilton, and Lucas counties. (D) Public notice by insurance industry (1) Whenever an insurance company or any individual or firm connected therewith, subject to the regulation and jurisdiction of the department of insurance, is required to give public notice by any section of the Revised Code of Ohio, in which the method and content of notice are not set forth with particularity, such public notice shall be given in accord with paragraph (C) of this rule hereof. (2) Such public notice shall include: (a) A synopsis or general statement of the subject matter involved. (b) An indication of the company's position, or action to be taken, regarding the subject of notice. (c) The date, time, and place of hearing, if any, or the effective date of action taken, or to be taken. (E) Discretion to vary publication Whenever the superintendent of insurance determines that the subject matter of public notice is of an unusual nature and appropriate for more widespread publication, the superintendent may direct that such notice be also made in newspapers of general circulation of not less than ten thousand in one or more of the following counties: Mahoning, Montgomery, Summit and Athens. Whenever the subject matter of public notice is of a regional nature, the superintendent of insurance may direct such special publication as appropriate. In any case, the superintendent of insurance may direct that publication be made more than once, as frequently as may be appropriate. In addition to the public notice provided by this rule, the superintendent of insurance may give, or order, such other means of notice as the superintendent deems necessary or appropriate. (F) Severability If any paragraph, term or provision of this rule is adjudged invalid for any reason, the judgment shall not affect, impair or invalidate any other paragraph, term or provision of this rule, but the remaining paragraphs, terms and provisions shall be and continue in full force and effect.
Last updated October 11, 2023 at 1:47 PM
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Rule 3901-1-02 | Access to confidential personal information.
(A) Purpose This rule is to regulate employee access to the
confidential personal information that the department of insurance (department)
keeps. This rule applies to both electronic records and records kept on
paper. (B) Authority This rule is promulgated under the authority of
division (B) of section 1347.15 of the Revised Code that requires each state
agency to adopt rules under Chapter 119. of the Revised Code to regulate access
to confidential personal information. Section 3901.041 of the Revised Code
provides that the superintendent of insurance (superintendent) shall adopt,
amend and rescind rules to discharge the superintendent's duties and
exercise the superintendent's powers. (C) Definitions For the purpose of this rule promulgated in
accordance with section 1347.15 of the Revised Code, the following definitions,
as set out by the department of administrative services in rule 123:3-2-01 of
the Administrative Code, apply: (1) "Access" as
a noun means an instance of copying, viewing, or otherwise perceiving whereas
"access" as a verb means to copy, view, or otherwise
perceive. (2) "Acquisition of
a new computer system" means the purchase of a "computer
system," as defined in this rule, that is not a computer system currently
in place nor one for which the acquisition process has been initiated as of the
effective date of the agency rule addressing requirements in section 1347.15 of
the Revised Code. (3) "Computer
system" means a "system," as defined by section 1347.01 of the
Revised Code, that stores, maintains, or retrieves personal information using
electronic data processing equipment. (4) "Confidential
personal information" (CPI) has the meaning as defined by division (A)(1)
of section 1347.15 of the Revised Code and identified by rules promulgated by
the agency in accordance with division (B)(3) of section 1347.15 of the Revised
Code that reference the federal or state statutes or administrative rules that
make personal information maintained by the agency confidential. (5) "Employee of the
state agency" means each employee of a state agency regardless of whether
he or she holds an elected or appointed office or position within the state
agency. "Employee of the state agency" is limited to the specific
employing state agency. (6) "Incidental
contact" means contact with the information that is secondary or
tangential to the primary purpose of the activity that resulted in the
contact. (7) "Individual" means a natural person or the natural
person's authorized representative, legal counsel, legal custodian, or
legal guardian. (8) "Information
owner" means the individual appointed in accordance with division (A) of
section 1347.05 of the Revised Code to be directly responsible for a
system. (9) "Person"
means a natural person. (10) "Personal
information" has the same meaning as defined in division (E) of section
1347.01 of the Revised Code. (11) "Personal
information system" means a "system" that "maintains"
"personal information" as those terms are defined in section 1347.01
of the Revised Code. "System" includes manual and computer
systems. (12) "Research"
means a methodical investigation into a subject. (13) "Routine"
means commonplace, regular, habitual, or ordinary. (14) "Routine
information that is maintained for the purpose of internal office
administration, the use of which would not adversely affect a person" as
that phrase is used in division (F) of section 1347.01 of the Revised Code
means personal information relating to employees and maintained by the agency
for internal administrative and human resource purposes. (15) "System"
has the same meaning as defined by division (F) of section 1347.01 of the
Revised Code. (16) "Upgrade"
means a substantial redesign of an existing computer system for the purpose of
providing a substantial amount of new application functionality, or application
modifications that would involve substantial administrative or fiscal resources
to implement, but would not include maintenance, minor updates and patches, or
modifications that entail a limited addition of functionality due to changes in
business or legal requirements. (D) Procedures for accessing confidential
personal information (as required by divisions (B)(1) and (B)(5) to (B)(8) of
section 1347.15 of the Revised Code). For personal information systems, whether manual
or computer systems, which contain confidential personal information, the
department shall do the following: (1) Criteria for
accessing confidential personal information Personal information systems of the department
are managed on a "need-to-know" basis whereby the information owner
determines the level of access required for an employee of the department to
fulfill his or her job duties. The determination of access to confidential
personal information shall be approved by the employee's supervisor and
the information owner prior to providing the employee with access to
confidential personal information within a personal information system. The
department shall establish procedures for determining a revision to an
employee's access to confidential personal information upon a change to
that employee's job duties including, but not limited to, transfer or
termination. Whenever an employee's job duties no longer require access to
confidential personal information in a personal information system, the
employee's access to confidential personal information shall be
removed. (2) Individual's
request for a list of confidential personal information Upon the signed written request of any
individual for a list of confidential personal information about the individual
maintained by the department, the department shall do all of the
following: (a) Verify the identity of the individual by a method that
provides safeguards commensurate with the risk associated with the confidential
personal information; (b) Provide to the individual the list of confidential personal
information that does not relate to an investigation about the individual or is
otherwise not excluded from the scope of Chapter 1347. of the Revised Code;
and (c) If all information relates to an investigation about that
individual, inform the individual that the agency has no confidential personal
information about the individual that is responsive to the individual's
request. (3) Notice of invalid
access (a) Upon discovery or notification that confidential personal
information of a person has been accessed by an employee for an invalid reason,
the department shall notify the person whose information was invalidly accessed
as soon as practical and to the extent known at the time. However, the
department shall delay notification for a period of time necessary to ensure
that the notification would not delay or impede an investigation or jeopardize
homeland or national security. Additionally, the department may delay the
notification consistent with any measures necessary to determine the scope of
the invalid access, including which individuals' confidential personal
information invalidly was accessed, and to restore the reasonable integrity of
the system. "Investigation" as used in this
paragraph means the investigation of the circumstances and involvement of an
employee surrounding the invalid access of the confidential personal
information. Once the department determines that notification would not delay
or impede an investigation, the department shall disclose the access to
confidential personal information made for an invalid reason to the
person. (b) Notification provided by the department shall inform the
person of the type of confidential personal information accessed and the
date(s) of the invalid access. (c) Notification may be made by any method reasonably designed to
accurately inform the person of the invalid access, including written,
electronic or telephone notice. (4) Appointment of a data
privacy point of contact The superintendent shall designate an employee
of the department to serve as the data privacy point of contact. The data
privacy point of contact shall work with the chief privacy officer within the
office of information technology to assist the department with both the
implementation of privacy protections for the confidential personal information
that the department maintains and compliance with section 1347.15 of the
Revised Code and the rules adopted pursuant to the authority provided by that
chapter. (5) Completion of a
privacy impact assessment The superintendent shall designate an employee
of the department to serve as the data privacy point of contact who shall
timely complete the privacy impact assessment form developed by the office of
information technology. (E) Valid reasons for accessing
confidential personal information (as required by division (B)(2) of section
1347.15 of the Revised Code) Pursuant to the requirements of division (B)(2)
of section 1347.15 of the Revised Code, this rule contains a list of valid
reasons, directly related to the department's exercise of its powers or
duties, for which only employees of the department may access confidential
personal information regardless of whether the personal information system is a
manual system or computer system. Performing the following functions constitute
valid reasons for authorized employees of the department to access confidential
personal information: (1) Responding to a
public records request; (2) Responding to a
request from an individual for the list of confidential personal information
the department maintains on that individual; (3) Administering a
constitutional provision or duty; (4) Administering a
statutory provision or duty; (5) Administering an
administrative rule provision or duty; (6) Complying with any
state or federal program requirements; (7) Processing or payment
of claims or otherwise administering a program with individual participants or
beneficiaries; (8) Auditing
purposes; (9) Licensure
processes; (10) Investigation or law
enforcement purposes; (11) Administrative
hearings; (12) Litigation,
complying with an order of the court, or subpoena; (13) Human resource
matters (e.g., hiring, promotion, demotion, discharge, salary and compensation
issues, leave requests and issues, time card approvals and
issues); (14) Complying with an
executive order or policy; (15) Complying with a
department policy or a state administrative policy issued by the department of
administrative services, the office of budget and management or other similar
state agency; or (16) Complying with a
collective bargaining agreement provision. (F) Confidentiality statutes (as required
by division (B)(3) of section 1347.15 of the Revised Code) The following federal statutes or regulations or
state statutes and administrative rules make personal information maintained by
the department confidential and identify the confidential personal information
within the scope of rules promulgated by the department in accordance with
section 1347.15 of the Revised Code: (1) Social security
numbers: 5 U.S.C. section 552a; "State ex rel. Beacon Journal Publishing
Co. v. City of Akron, 70 Ohio St.3d 605 (1994)." (2) Consumer credit
reporting information: limits the use that can be made of consumer credit
reports: 15 U.S.C. section 1681b. (3) Federal tax returns
and return information: 26 U.S.C. section 6103(a). (4) Medical records
pertaining to an eligible person under the American with Disabilities Act: 42
U.S.C. section 12112(d)(3)(B). (5) Bureau of criminal
identification and investigation records: division (H) of section 109.57 of the
Revised Code and section 4776.04 of the Revised Code. (6) Public employees
retirement system (PERS) information (the individual's statement of
previous service, amount of a monthly allowance or benefit paid to an
individual and the individual's personal history record that includes
address, telephone number, social security number, record of contributions,
correspondence with the public employees retirement system or other information
determined by the public employees retirement board to be confidential):
division (A) of section 145.27 of the Revised Code. (7) Medical reports and
recommendations required by the public employees retirement system: division
(B) of section 145.27 of the Revised Code. (8) Deferred
compensation program participant information: divisions (A) and (B) of section
148.05 of the Revised Code. (9) Medical records:
division (A)(1)(a) of section 149.43 of the Revised Code. (10) Confidential law
enforcement investigatory records: division (A)(1)(h) of section 149.43 of the
Revised Code. (11) Security and
infrastructure records: section 149.433 of the Revised Code. (12) Health insuring corporation complaint
and response documents and information that contain medical records provided to
the superintendent: division (C) of section 1751.19 of the Revised
Code. (13) Any data or information pertaining to
the diagnosis, treatment, or health of any enrollee or applicant for enrollment
that is obtained by the health insuring corporation from the enrollee or
applicant, or from any health care facility or provider: division (B) of
section 1751.52 of the Revised Code. (14) Peer review committee records:
sections 1751.21 and 2305.252 of the Revised Code. (15) Medical records; doctor patient
communications: division (B) of section 2317.02 of the Revised Code; "TBC
Westlake, Inc. v. Hamilton Cty. Bd. of Revision, 81 Ohio St.3d 58, 62
(1998)." (16) Identity of an individual on whom an
HIV test is performed, the results of the test and the identity of any
individual diagnosed as having AIDS or an AIDS-related condition: section
3701.243 of the Revised Code. (17) Records pertaining to an insurance
fraud investigation are confidential law enforcement investigatory records
(CLEIR) and are protected to the extent of the CLEIR exemption from section
149.43 of the Revised Code until the expiration of all applicable federal and
state statutes of limitation: section 3901.44 of the Revised Code. (18) Applicant HIV test results required
by insurers when underwriting fraternal policies: section 3901.46 of the
Revised Code. (19) Records and
information pertaining to an investigation of a license applicant or of an
agent, solicitor, broker or a person licensed under the code sections covering
public insurance adjusters and third party administrators until notice and
opportunity for hearing is given or until three years have passed since the
close of the investigation: section 3905.24 of the Revised Code. (20) All medical
information solicited or obtained by any viatical settlement licensee: division
(G) of section 3916.07 of the Revised Code. (21) Names and individual
identification data for all viators: division (D)(1) of section 3916.11 of the
Revised Code. (22) All proprietary
information of a viatical settlement licensee, all individual transaction data
regarding the business of viatical settlements and data that could compromise
the privacy of personal, financial and health information of the viator or
insured: division (E) of section 3916.12 of the Revised Code. (23) With certain
specified exceptions, identity as a viator or a viatical settlement insured,
including the viator's or the insured's name and individual
identification data, or the viator or the insured's financial or medical
information: section 3916.13 of the Revised Code. (24) Documents and
evidence provided to or obtained by the superintendent in an investigation of
any suspected or actual fraudulent viatical settlement acts or fraudulent
insurance acts: division (E)(1) of section 3916.18 of the Revised
Code. (25) Records containing
information pertaining to the medical history, diagnosis, prognosis or medical
condition of a covered person pursuant to the external review laws under
Chapter 3922. of the Revised Code and sections 1751.77 to 1751.87 of the
Revised Code: section 3922.21 of the Revised Code. (26) Medical claims data required to be
reported to the superintendent by section 3929.302 of the Revised Code:
division (G) of section 3929.302 of the Revised Code. (27) Driver's license number or state
identification card number: section 4501.27 of the Revised Code and 18 U.S.C.
sections 2721 and 2725. (28) Law enforcement automated data system
(LEADS) information: section 5503.10 of the Revised Code and rule 4501:2-10-06
of the Administrative Code. (29) Any information gained as the result
of returns, investigations, hearings, or verifications required or authorized
by Chapter 5747. of the Revised Code on income tax: section 5747.18 of the
Revised Code. (30) Personal
information: division (A)(1)(dd) of section 149.43 of the Revised Code, based
on the definitions in division (A)(1) of section 149.45 of the Revised
Code. (31) Records
and documents relating to certifications, recertifications or medical histories
of employees' family members, created for purposes of the Family and
Medical Leave Act: 29 C.F.R. section 825.500(g). As statutes are enacted or amended and rules are
promulgated or revised, the list of confidentiality provisions provided in this
rule may be subject to change. Any changes that occur before the time of the
five-year rule review process for this rule shall be available to any requester
by making a request to the department's office of legal services. (G) Restricting and logging access to
confidential personal information in computerized personal information systems
(as required by divisions (B)(4) and (B)(9) of section 1347.15 of the Revised
Code) For personal information systems that are
computer systems and contain confidential personal information, the department
shall do the following: (1) Access
restrictions Access to confidential personal information
that is kept electronically shall require a password or other authentication
measure. (2) Acquisition of a new
computer system When the department acquires a new computer
system that stores, manages or contains confidential personal information, the
department shall include a mechanism for recording specific access by employees
of the department to confidential personal information in the system. (3) Upgrading existing
computer systems When the department modifies an existing
computer system that stores, manages or contains confidential personal
information, the department shall make a determination whether the modification
constitutes an upgrade. Any upgrades to a computer system shall include a
mechanism for recording specific access by employees of the department to
confidential personal information in the system. (4) Logging requirements
regarding confidential personal information in existing computer
systems (a) The department shall require employees of the department who
access confidential personal information within computer systems to maintain a
log that records that access. (b) Access to confidential personal information is not required
to be entered into the log under the following circumstances: (i) The employee of the
department is accessing confidential personal information for official
department purposes, including research, and the access is not specifically
directed toward a specifically named individual or a group of specifically
named individuals. (ii) The employee of the
department is accessing confidential personal information for routine office
procedures and the access is not specifically directed toward a specifically
named individual or a group of specifically named individuals. (iii) The employee of the
department comes into incidental contact with confidential personal information
and the access of the information is not specifically directed toward a
specifically named individual or a group of specifically named
individuals. (iv) The employee of the
department accesses confidential personal information about an individual based
upon a request made under either of the following circumstances: (a) The individual
requests confidential personal information about himself or
herself. (b) The individual makes
a request that the department takes some action on that individual's
behalf and accessing the confidential personal information is required in order
to consider or process that request. (c) For purposes of this paragraph, the department may choose the
form or forms of logging, whether in electronic or paper formats. (5) Log
management The department shall issue a policy that
specifies the following: (a) Who shall maintain the log; (b) What information shall be captured in the log; (c) How the log is to be stored; and (d) How long information kept in the log is to be
retained. Nothing in this rule limits the department from
requiring logging in any circumstance that the department deems
necessary. (H) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated May 10, 2021 at 10:10 AM
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Rule 3901-1-05 | Insider trading -- instructions and forms.
Effective:
November 14, 2019
(A) Purpose The purpose of this rule is to promulgate procedures and forms to be adhered to in filing initial statements of changes in beneficial ownership of any equity security. Effective April 4, 1985, division (A) of section 3901.31 of the Revised Code was amended to exclude from application of this filing requirement domestic stock insurance companies which are wholly owned subsidiaries of an insurance holding company system. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under division (H) of section 3901.31 of the Revised Code, which empowers the superintendent to adopt, amend, and rescind rules, pursuant to Chapter 119. of the Revised Code, which will enable the superintendent to carry out the duties imposed by section 3901.31 of the Revised Code. Division (A) of section 3901.31 of the Revised Code requires every person who is directly or indirectly the beneficial owner of more than ten per cent of any class of any equity security of a domestic stock insurance company or who is a director or officer of such company to file with the superintendent of insurance on or before January 31, 1966, or within ten days after the person becomes such beneficial owner, director, or officer, a statement in such form as the superintendent of insurance may prescribe of the amount of all equity securities of such company of which the person is the beneficial owner, and within ten days after the close of each calendar month thereafter, if there has been a change in such ownership during such month, to file with the superintendent of insurance a statement, in such form as the superintendent of insurance may prescribe, indicating the person's ownership at the close of the calendar month and such changes in the person's ownership as have occurred during such calendar month. (C) Filing of statements (1) Initial statements of beneficial ownership of equity securities shall be filed on form I.S.S., as set forth in paragraph (D)(9) of this rule. Statements of changes in such beneficial ownership shall be filed on form C.S.S., as set forth in paragraph (E)(11) of this rule. All such statements shall be prepared in accordance with the requirements of the applicable form and filed as required. (2) Form I.S.S. (a) A statement on form I.S.S. shall be filed by every person who is directly or indirectly the beneficial owner of more than ten per cent of any class of equity security of a domestic stock insurance company or who is a director or officer of such company. (b) When section 3901.31 of the Revised Code became law, persons who held any of the relationships specified in paragraph (C)(2) of this rule were required to file a statement on form I.S.S. on or before January 31, 1966. Persons who subsequently assume any of the specified relationships are required to file a statement within ten days after assuming such relationship. (c) A separate statement shall be filed with respect to the securities of each domestic stock insurance company. (3) Form C.S.S. (a) A statement on form C.S.S. shall be filed by every person who is directly or indirectly the beneficial owner of more than ten per cent of any class of equity security of a domestic stock insurance company or who is a director or officer of such company, who has filed a Form I.S.S. with the department, and who has during any month had any change in his beneficial ownership of any class of equity security of such company. Any beneficial owner, director, or officer who is required to file a statement on form C.S.S. with respect to any change in his beneficial ownership of equity securities which occurs within six months after he became a beneficial owner, director, or officer of such company shall include in the first such statement the information called for by form C.S.S. with respect to all changes in his beneficial ownership of equity securities of such company which occurred within six months prior to the filing of such statement. (b) A statement on form C.S.S. shall be filed by any person who has ceased to be such beneficial owner, director, or officer of a domestic stock insurance company with respect to any change in his beneficial ownership of equity securities of such company which occurs on or after the date on which he ceased to be such beneficial owner, director, or officer if such change occurs within six months after any change in his beneficial ownership of such securities prior to such date. (c) Statements on form C.S.S. which are required to be filed shall be filed on or before the tenth day after the end of each month in which any change in beneficial ownership has occurred. A separate statement shall be filed with respect to the securities of each domestic stock insurance company. (4) Any person who has ceased to be a beneficial owner, director, or officer of a domestic stock insurance company shall give written notice to the superintendent of insurance of the date on which he ceased to be such beneficial owner, director, or officer within thirty days after said date. (D) Instructions - form I.S.S.: initial statement of beneficial ownership of equity securities (1) Where statements are to be filed (a) One signed, sworn to copy of each statement shall be filed with the Ohio department of insurance. (b) A statement is not deemed to have been filed in the office of the superintendent of insurance until it has actually been received by the department. (2) Relationship of reporting person to company. Indicate clearly the relationship of the reporting person to the company; for example, "director," "director and vice president," "beneficial owner of more than ten per cent of the company's common stock," etc. (3) Dates as of which beneficial ownership is to be given. The information as to beneficial ownership of securities shall be given as of the date on which the event occurred which requires the filing of a statement on this form; for example, when the person whose ownership is reported became a director or officer of the company or a beneficial owner of more than ten per cent of the company's equity securities. (4) Title of security The statement of the title of a security shall be such as clearly to identify the security even though there may be only one class; for example, "Class A Common," "5% Debentures Due 1965," etc. (5) Nature of ownership. Under "nature of ownership," state whether ownership of the securities is "direct" or "indirect." If the ownership is indirect, i.e., through a partnership, corporation, trust or other entity, indicate in a footnote, or other appropriate manner, the name or identity of the medium through which the securities are indirectly owned. The fact that securities are held in the name of a broker or other nominee does not, of itself constitute indirect ownership. Securities owned indirectly shall be reported on separate lines from those owned directly and also from those owned through a different type of indirect ownership. (6) Statement of amount owned. In stating the amount of securities beneficially owned, give the face amount of debt securities or the number of shares or other units of other securities. In the case of securities owned indirectly, the entire amount of securities owned by the partnership, corporation, trust or other entity, shall be stated. The person whose ownership is reported may, if he so desires, also indicate in a footnote, or other appropriate manner, the extent of his interest in the partnership, corporation, trust or other entity. (7) Inclusion of additional information. A statement may include any additional information or explanation deemed relevant by the person filing statement. (8) Signature. (a) If the statement is filed for a corporation, partnership, trust, etc., the name of the organization shall appear over the signature of the officer or other person authorized to sign the statement. If the statement is filed for an individual, it shall be signed by him or specifically on his behalf by a person authorized to sign for him. (b) In those cases where the statement is signed by someone other than the person whose ownership is being reported, documentary evidence of the signing authority shall be filed with the statement. (c) In all cases, the signature must be duly notarized. (9) Form I.S.S. "STATE OF OHIO | DEPARTMENT OF INSURANCE | Form I.S.S. | INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF EQUITY SECURITIES | Filed Pursuant to Section 3901.31, Ohio Revised Code | Name of insurer ___________________________________________________ | Name of person whose Ownership is reported ____________________________ | Business address of such person ______________________________________ | | (Street, City, State, Zip Code) | Relationship of such person to company named above ______________________ | Date of event which requires the filing of this statement ______________________ |
SECURITIES BENEFICIALLY OWNED | Title of Security | Nature of Ownership | Amount Owned Beneficially | | | | | | | Remarks: (For Additional Space - Use Reverse Side) |
| I affirm under the penalty of perjury that the foregoing is full, true and correct. | | ________________________________ | | Signature | ________________________________ | | Date of Statement | | | | Subscribed and sworn to before me this_________day of _________ ,20________ | | | ________________________________ | | Notary Public" | |
(E) Instruction - Form C.S.S.: Statement of changes in beneficial ownership of equity securities (1) Where statements are to be filed. (a) One signed, sworn to copy of each statement shall be filed with the Ohio department of insurance. (b) A statement is not deemed to have been filed in the office of the superintendent of insurance until it has actually been received by the department. (2) Relationship of reporting person to company. Indicate clearly the relationship of the reporting person to the company; for example, "director," "director and vice president," "beneficial owner of more than ten per cent of the company's common stock," etc. (3) Transactions and holdings to be reported. Every transaction shall be reported even though purchases and sales during the month are equal or the change involves only the nature of ownership; for example, from direct or indirect ownership. Beneficial ownership at the end of the month of all classes of securities required to be reported shall be shown even though there has been no change during the month in the ownership of securities of one or more classes. (4) Title of security. The statement of the title of the security shall be such as to clearly identify the security even though there may be only one class; for example, "Class A Common," "5% Debentures Due 1965," etc. (5) Date of transaction. The exact date (month, day and year) of each transaction shall be stated opposite the amount involved in the transactions. (6) Statement of amounts of securities. In stating the amount of the securities acquired, disposed of, or beneficially owned, give the face stated. The person whose ownership is reported may, if he so desires, also indicate in a footnote, or other appropriate manner, the extent of his interest in the transaction or holdings of the partnership, corporation, trust or other entity. (7) Nature of ownership. Under "nature of ownership," state whether ownership of the securities is "direct" or "indirect." If the ownership is indirectly, i.e., through a partnership, corporation, trust or other entity, indicate in a footnote, or other appropriate manner, the name or identity of the medium through which the securities are indirectly owned. The fact that securities are held in the name of the broker or other nominee does not, of itself, constitute indirect ownership. Securities owned indirectly shall be reported on separate lines from securities owned directly and from securities owned through a different type of indirect ownership. (8) Character of transaction. If the transaction was with the issuer of the securities, so state. If it involved the purchase of securities through the exercise of options, so state and give the exercise price per share. If any other purchase or sale was effected otherwise than in the open market, the fact shall be indicated. If the transaction was not a purchase or sale, indicate its character; for example, gift, stock dividend, etc., as the case may be. The foregoing information may be appropriately set forth in the table or under "remarks" at the end of the table. (9) Inclusion of additional information. A statement may include any additional information or explanation deemed relevant by the person filing the statement. (10) Signature. (a) If the statement is filed for a corporation, partnership, trust, etc., the name of the organization shall appear over the signature of the officer or other person authorized to sign the statement. If the statement is filed for an individual, it shall be signed by him or specifically on his behalf by a person authorized to sign for him. (b) In those cases where the statement is signed by someone other than the person whose partnership is being reported, documentary evidence of the signing authority shall be filed with the statement. (c) In all cases, the signature must be duly notarized. (11) Form C.S.S. "STATE OF OHIO | DEPARTMENT OF INSURANCE | Form C.S.S. | STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF EQUITY SECURITIES | Filed Pursuant to Section 3901.31, Ohio Revised Code | Name of insurer ___________________________________________________ | Name of person whose Ownership is reported ____________________________ | Business address of such person ______________________________________ | | (Street, City, State, Zip Code) | Relationship of such person to company named above ______________________ |
Statement for Calendar Month of ________________, 20_____ | Changes During Month and Month-End Ownership | Title of Security | Date of Transaction | Amount Bought or Otherwise Acquired | Amount Sold or Otherwise Disposed of | Nature of Ownership | Amount Owned Beneficially at end of Month | | | | | | | | | | | | | Remarks: (For Additional Space - Use Reverse Side) |
| I affirm under the penalty of perjury that the foregoing is full, true and correct. | | ________________________________ | | Signature | ________________________________ | | Date of Statement | | | | Subscribed and sworn to before me this_________day of _________ ,20________ | | | ________________________________ | | Notary Public" | |
(F) Failure to file Division (B) of section 3901.99 of the Revised Code provides that "Whoever violates any law relating to the superintendent of insurance, or any law of this state, relating to insurance as defined in division (A)(1) of section 3901.04 of the Revised Code for the violation of which no penalty is otherwise provided in the Revised Code, shall be fined not more than twenty-five thousand dollars, imprisoned not more than six months, or both." (G) Severability If any paragraph, term or provision of this rule is adjudged invalid for any reason, the judgment shall not affect, impair or invalidate any other paragraph, term or provision of this rule, but the remaining paragraphs, terms and provisions shall be and continue in full force and effect.
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Rule 3901-1-07 | Unfair trade practices.
Effective:
February 14, 2022
(A) Purpose The purpose of this rule is to define certain
additional unfair trade practices and to set forth required procedures in
connection therewith. 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. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under section 3901.041 of the Revised
Code. Section 3901.041 of the Revised Code provides that the superintendent of
insurance shall adopt, amend, and rescind rules and make adjudications
necessary to discharge the superintendent's duties and exercise that
person's powers under Title 39 of the Revised Code. (C) Defined unfair practices It shall be deemed an unfair or deceptive
practice to commit or perform with such frequency as to indicate a general
business practice any of the following: (1) Knowingly
misrepresenting to claimants pertinent facts or policy provisions relating to
coverage at issue; (a) Misrepresenting a pertinent policy provision by making any
payment, settlement, or offer of first party benefits, which, without
explanation, does not include all amounts which should be included according to
the claim filed by the first party claimant and investigated by the
insurer; (b) Denying a claim on the grounds of a specific policy
provision, condition, or exclusion without reference to such provision,
condition, or exclusion; (2) Failing to
acknowledge pertinent communications with respect to claims arising under
insurance policies in writing, or by other means so long as an appropriate
notation is made in the claim file of the insurer, within fifteen days of
receiving notice of a claim in writing or otherwise; (3) Failing to make an
appropriate reply within twenty-one days of all other pertinent communications
and/or any inquiries of the department of insurance respecting a
claim; (4) Failing to adopt and
implement reasonable procedures to commence an investigation of any claim filed
by either a first party or third party claimant, or by such claimant's
authorized representative, within twenty-one days of receipt of notice of
claim; (5) Failing to mail or
furnish claimant or the claimant's authorized representative, a
notification of all items, statements and forms, if any, which the insurer
reasonably believes will be required of such claimant, within fifteen days of
receiving notice of claim, unless the insurer, based on the information then in
its possession does not yet know all such requirements, then such notification
shall be sent, within a reasonable time; (6) Not offering first
party or third party claimants, or their authorized representatives who have
made claims which are fair and reasonable and in which liability has become
reasonably clear, amounts which are fair and reasonable as shown by the
insurer's investigation of the claim, providing the amounts so offered are
within policy limits and in accordance with the policy provisions; (7) Compelling insureds
to institute suits to recover amounts due under its policies by offering
substantially less than the amounts ultimately recovered in suits brought by
them when such insureds have made claims for amounts reasonably similar to the
amounts ultimately recovered; (8) Making known to
insureds or claimants a policy of appealing from arbitration awards in favor of
insureds or claimants for the purpose of compelling them to accept settlements
or compromises less than the amount awarded in arbitration; (9) Attempting settlement
or compromise of claims on the basis of applications which were altered without
notice to, or knowledge, or consent of insureds; (10) Attempting to settle
or compromise claims for less than the amount which the insureds had been led
reasonably to believe they were entitled to, by written or printed advertising
material accompanying or made part of an application; (11) Attempting to delay
the investigation or payment of claims by requiring an insured and his
physician to submit a preliminary claim report and then requiring the
subsequent submission of formal proof of loss forms, both of which submissions
contain substantially the same information; (12) Failing to advise
the first party claimant or the claimant's authorized representative, in
writing or by other means so long as an appropriate notation is made in the
claim file of the insurer, of the acceptance or rejection of the claim, within
twenty-one days after receipt by the insurer of a properly executed proof of
loss; (a) Failing to notify such claimant or the claimant's
authorized representative, within twenty-one days after receipt of such proof
of loss, that the insurer needs more time to determine whether the claim should
be accepted or rejected; (b) Failing to send a letter to such claimant or, the
claimant's authorized representative, stating the need for further time to
investigate the claim, if such claim remains unsettled ninety days from the
date of the initial letter setting forth the need for further time to
investigate; (c) Failing to send to such claimant or authorized representative
every ninety days after the first ninety-day claim investigation period, a
letter setting forth the reasons additional time is needed for investigation,
unless the delay is caused by factors beyond the insurer's
control; (13) Failing to advise
such claimant or claimant's authorized representative, of the amount
offered, if such claim is accepted in whole or in part; (14) Refusing payments of
claims solely on the basis of the insured's request to do so without
making an independent evaluation of the insured's liability based upon all
available information; (15) Failing to adopt and
implement reasonable standards for the proper handling of written
communications, primarily expressing grievances, received by the insurer from
insureds or claimants; (16) Failing to pay any
amount finally agreed upon in settlement of all or part of any claim or
authorized repairs to be made upon final agreement not later than five days
from the receipt of such agreement by the insurer at the place from which the
payment or authorization is to be made or from the date of the performance by
the claimant of any condition set by such agreement, whichever is
later. (17) For purposes of this
rule, the following definitions shall apply; (a) "Investigation" shall mean all activities of the
company related directly or indirectly to the determining of liabilities under
the coverages afforded by the policy. This shall include, but not be limited
to, a bona fide effort to contact all insureds and claimants within a
reasonable period after notification of loss. Evidence of a bona fide effort
must be maintained in the file. The investigation shall be deemed concluded
upon the company's affirmation or denial of liability. (b) "Notice of Claim" as applied to an insurer shall
include notification given to an agent of an insurer. (c) "Settlement of claims" shall mean all activities of
the company related directly or indirectly to the determination of the extent
of damages due under coverages afforded by the policy. This shall include, but
not be limited to, the requiring or preparing of repair estimates. (d) "Days" means calendar days. However, when the last
day of a time limit stated in this rule falls on a Saturday, Sunday or holiday,
the time limit is extended to the next immediate following day that is not a
Saturday, Sunday or holiday. (D) Severability If any paragraph, term, or provision of this rule
be adjudged invalid for any reason, such judgment shall not affect, impair, or
invalidate any other paragraph, term, or provision of this rule, but the
remaining paragraphs, terms, and provisions shall be in and continue in full
force and effect.
Last updated February 14, 2022 at 8:54 AM
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Rule 3901-1-08 | Unfair and deceptive military sales practices.
Effective:
November 3, 2016
(A) Purpose The purpose of this rule is to further define
unfair trade practices to include dishonest and predatory practices involving
the sale of certain life insurance products to active duty members of the
United States armed forces and their families and to set acceptable standards
for such sales. Sections 3901.20 and 3901.21 of the Revised Code, respectively,
prohibit unfair or deceptive trade 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. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under section 3901.041 of the Revised
Code. (C) 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. (D) Application This rule applies to the solicitations and sales
of life insurance and annuity products by insurers and insurance agents to
active duty members of the United States armed forces and their families. This
rule applies in addition to other statutes and rules governing the sale and
solicitations of life insurance and annuity products. (E) Exemptions (1) This rule shall not
apply to solicitations or sales involving: (a) Credit insurance; (b) Group life insurance or group annuities where there is
no in-person, face-to-face solicitation of individuals by an insurance agent or
where the contract or certificate does not include a side fund; (c) An application to the existing insurer that issued the
existing policy or contract when a contractual change or a conversion privilege
is being exercised; or, when the existing policy or contract is being replaced
by the same insurer pursuant to a program filed with and approved by the
superintendent; or, when a term conversion privilege is exercised among
corporate affiliates; (d) Individual stand-alone health policies, including
disability income policies; (e) Contracts offered by "Servicemembers' Group
Life Insurance" (SGLI) or "Veterans' Group Life Insurance"
(VGLI), as authorized by 38 U.S.C. sections 1965 to 1979; (f) Life insurance contracts offered through or by a
non-profit military association, qualifying under section 501(c)(23) of the
"Internal Revenue Code" (IRC), and which are not underwritten by an
insurer; or (g) Contracts used to fund: (i) An employee pension
or welfare benefit plan that is covered by the "Employee Retirement and
Income Security Act" (ERISA); (ii) A plan described by
section 401(a), 401(k), 403(b), 408(k) or 408(p) of the IRC, as amended, if
established or maintained by an employer; (iii) A government or
church plan defined in section 414 of the IRC, a government or church welfare
benefit plan, or a deferred compensation plan of a state or local government or
tax exempt organization under section 457 of the IRC; (iv) A nonqualified
deferred compensation arrangement established or maintained by an employer or
plan sponsor; (v) Settlements of or
assumptions of liabilities associated with personal injury litigation or any
dispute or claim resolution process; or (vi) Prearranged funeral
contracts. (2) Nothing herein shall
be construed to abrogate the ability of nonprofit organizations (and/or other
organizations) to educate members of the "United States Armed Forces"
in accordance with "Department of Defense DoD Instruction 1344.07 -
Personal Commercial Solicitation on DoD Installations" or successor
directive. (3) For purposes of this
rule, general advertisements, direct mail and internet marketing shall not
constitute "solicitation." Telephone marketing shall not constitute
"solicitation" provided the caller explicitly and conspicuously
discloses that the product concerned is life insurance and makes no statements
that avoid a clear and unequivocal statement that life insurance is the subject
matter of the solicitation. However, nothing in this subdivision shall be
construed to exempt an insurer or insurance agent from this rule in any
in-person, face-to-face meeting established as a result of the
"solicitation" exemptions identified in this
subdivision. (F) Definitions (1) "Active
duty" means full-time duty in the active military service of the United
States and includes members of the reserve component (national guard and
reserve) while serving under published orders for active duty or full-time
training and all service in the uniformed services under the "Uniformed
Services Employment and Reemployment Rights Act" (USERRA). The term does
not include members of the reserve component who are performing active duty or
active duty for training under military calls or orders specifying periods of
fewer than thirty-one calendar days. (2) "Department of
Defense (DoD) Personnel" means all active duty service members and all
civilian employees, including nonappropriated fund employees and special
government employees, of the "Department of Defense." (3) "Door to
door" means a solicitation or sales method whereby an insurance agent
proceeds randomly or selectively from household to household without prior
specific appointment. (4) "General
advertisement" means an advertisement having as its sole purpose the
promotion of the reader's or viewer's interest in the concept of
insurance, or the promotion of the insurer or the insurance agent. (5) "Insurer"
means an insurance company required to be licensed under the laws of this state
to provide life insurance products, including annuities. (6) "Insurance
agent" means a person required to be licensed under the laws of this state
to sell, solicit or negotiate life insurance, including annuities. (7) "Known" or
"Knowingly" means, depending on its use herein, the insurance agent
or insurer had actual awareness, or in the exercise of ordinary care should
have known, at the time of the act or practice complained of, that the person
solicited: (a) Is a service member; or (b) Is a service member with a pay grade of E-4 or
below. (8) "Life
insurance" means insurance coverage on human lives including benefits of
endowment and annuities, and may include benefits in the event of death or
dismemberment by accident and benefits for disability income and, unless
otherwise specifically excluded, includes individually issued
annuities. (9) "Military
installation" means any state or federally owned, leased, or operated
base, reservation, post, camp, building, or other facility to which service
members are assigned for duty, including barracks, transient housing, and
family quarters. (10) "MyPay" is
a "Defense Finance and Accounting Service" (DFAS) web-based system
that enables service members to process certain discretionary pay transactions
or provide updates to personal information data elements without using paper
forms. (11) "Service in the
uniformed services" and "uniformed services" have the same
meanings as in the "Uniformed Services Employment and Reemployment Rights
Act of 1994," 108 Stat. 3149, 38 U.S.C. 4303, as amended, June 5,
2001. (12) "Service
member" means any active duty officer (commissioned and warrant) or
enlisted member of the United States armed forces. (13) "Side
fund" means a fund or reserve that is part of or otherwise attached to a
life insurance policy (excluding individually issued annuities) by rider,
endorsement or other mechanism, which accumulates premium or deposits, with
interest, or by other means. The term does not include: (a) Accumulated value or cash value or secondary guarantees
provided by a universal life policy; (b) Cash values provided by a whole life policy which are
subject to standard nonforfeiture laws for life insurance; or (c) A premium deposit fund which: (i) Contains only
premiums paid in advance that accumulate at interest; (ii) Imposes no penalty
for withdrawal; (iii) Does not permit
funding beyond future required premiums; (iv) Is not marketed or
intended as an investment; and (v) Does not carry a
commission, either paid or calculated. (14) "Specific
appointment" means a prearranged appointment agreed upon by both parties
and definite as to place and time. (15) "United States
Armed Forces" means all components of the army, navy, air force, marine
corps, and coast guard. (G) Practices declared false, misleading,
deceptive or unfair on a military installation (1) The following acts or
practices, when committed on a military installation by an insurer or insurance
agent with respect to the in-person, face-to-face solicitation of life
insurance, are declared to be false, misleading, deceptive or
unfair: (a) Knowingly soliciting the purchase of any life insurance
product "door to door" or without first establishing a specific
appointment for each meeting with the prospective purchaser. (b) Soliciting service members in a group or
"mass" audience or in a "captive" audience where attendance
is not voluntary. (c) Knowingly making appointments with or soliciting
service members during their normally scheduled duty hours. (d) Making appointments with or soliciting service members
in barracks, day rooms, unit areas, or transient personnel housing or other
areas where the installation commander has prohibited
solicitation. (e) Soliciting the sale of life insurance without first
obtaining permission from the installation commander or the commander's
designee. (f) Posting unauthorized bulletins, notices or
advertisements. (g) Failing to present "DD Form 2885, Personal
Commercial Solicitation Evaluation," to service members solicited or
encouraging service members solicited not to complete or submit a "DD Form
2885." (h) Knowingly accepting an application for life insurance
or issuing a policy of life insurance on the life of an enlisted member of the
United States armed forces without first obtaining, for the insurer's
files, a completed copy of any required form which confirms that the applicant
has received counseling or fulfilled any other similar requirement for the sale
of life insurance established by rules or directives of the "DoD" or
the rules or directives of any branch of the armed forces. (2) The following acts or
practices when committed on a military installation by an insurer or insurance
agent constitute corrupt practices, improper influences or inducements and are
declared to be false, misleading, deceptive or unfair: (a) Using "DoD" personnel, directly or
indirectly, as a representative or agent in any official or business capacity,
with or without compensation, with respect to the solicitation or sale of life
insurance to service members. (b) Using an insurance agent to participate in any United
States armed forces sponsored education or orientation program. (H) Practices declared false, misleading,
deceptive or unfair regardless of location (1) The following acts or
practices by an insurer or insurance agent constitute corrupt practices,
improper influences or inducements and are declared to be false, misleading,
deceptive or unfair: (a) Submitting, processing or assisting in the submission
or processing of any allotment form or similar device used by the United States
armed forces to direct a service member's pay to a third party for the
purchase of life insurance. The foregoing includes, but is not limited to,
using or assisting in using a service member's "MyPay" account
or other similar internet or electronic medium for such purposes. This
paragraph does not prohibit assisting a service member by providing insurer or
premium information necessary to complete any allotment form. (b) Knowingly receiving funds from a service member for the
payment of premium from a depository institution with which the service member
has no formal banking relationship. For purposes of this rule, a "formal
banking relationship" is established when the depository
institution: (i) Provides the service
member a deposit agreement and periodic statements and makes the disclosures
required by the "Truth in Savings Act," 12 U.S.C. sections 4301 to
4313 (1992) and the rules promulgated thereunder; and (ii) Permits the service
member to make deposits and withdrawals unrelated to the payment or processing
of insurance premiums. (c) Employing any device or method or entering into any
agreement whereby funds received from a service member by allotment for the
payment of insurance premiums are identified on the service member's
"Leave and Earnings Statement" or equivalent or successor form as
"savings" or "checking" and where the service member has no
formal banking relationship as defined in paragraph (H)(1)(b) of this
rule. (d) Entering into any agreement with a depository
institution for the purpose of receiving funds from a service member whereby
the depository institution, with or without compensation, agrees to accept
direct deposits from a service member with whom it has no formal banking
relationship as defined in paragraph (H)(1)(b) of this rule. (e) Using "DoD" personnel, directly or
indirectly, as a representative or agent in any official or unofficial capacity
with or without compensation with respect to the solicitation or sale of life
insurance to service members who are junior in rank or grade, or to the family
members of such personnel. (f) Offering or giving anything of value, directly or
indirectly, to "DoD" personnel to procure their assistance in
encouraging, assisting or facilitating the solicitation or sale of life
insurance to another service member. (g) Knowingly offering or giving anything of value to a
service member with a pay grade of E-4 or below for his or her attendance to
any event where an application for life insurance is solicited. (h) Advising a service member with a pay grade of E-4 or
below to change his or her income tax withholding or State of legal residence
for the sole purpose of increasing disposable income to purchase life
insurance. (2) The following acts or
practices by an insurer or insurance agent lead to confusion regarding source,
sponsorship, approval or affiliation and are declared to be false, misleading,
deceptive or unfair: (a) Making any representation, or using any device, title,
descriptive name or identifier that has the tendency or capacity to confuse or
mislead a service member into believing that the insurer, insurance agent or
product offered is affiliated, connected or associated with, endorsed,
sponsored, sanctioned or recommended by the U.S. government, the "United
States Armed Forces," or any state or federal agency or government entity.
Examples of prohibited insurance agent titles include, but are not limited to,
"Battalion Insurance Counselor," "Unit Insurance Advisor,"
"Servicemen's Group Life Insurance Conversion Consultant" or
"Veteran's Benefits Counselor." Nothing herein shall be construed to prohibit
a person from using a professional designation awarded after the successful
completion of a course of instruction in the business of insurance by an
accredited institution of higher learning. Such designations include, but are
not limited to, "Chartered Life Underwriter" (CLU), "Chartered
Financial Consultant" (ChFC), "Certified Financial Planner"
(CFP), "Master of Science In Financial Services" (MSFS), or
"Masters of Science Financial Planning" (MS). (b) Soliciting the purchase of any life insurance product
through the use of or in conjunction with any third party organization that
promotes the welfare of or assists members of the United States armed forces in
a manner that has the tendency or capacity to confuse or mislead a service
member into believing that either the insurer, insurance agent or insurance
product is affiliated, connected or associated with, endorsed, sponsored,
sanctioned or recommended by the U.S. government, or the United States armed
forces. (3) The following acts or
practices by an insurer or insurance agent lead to confusion regarding
premiums, costs or investment returns and are declared to be false, misleading,
deceptive or unfair: (a) Using or describing the credited interest rate on a
life insurance policy in a manner that implies that the credited interest rate
is a net return on premium paid. (b) Excluding individually issued annuities,
misrepresenting the mortality costs of a life insurance product, including
stating or implying that the product "costs nothing" or is
"free." (4) The following acts or
practices by an insurer or insurance agent regarding SGLI or VGLI are declared
to be false, misleading, deceptive or unfair: (a) Making any representation regarding the availability,
suitability, amount, cost, exclusions or limitations to coverage provided to a
service member or dependents by SGLI or VGLI, which is false, misleading or
deceptive. (b) Making any representation regarding conversion
requirements, including the costs of coverage, or exclusions or limitations to
coverage of SGLI or VGLI to private insurers, which is false, misleading or
deceptive. (c) Suggesting, recommending or encouraging a service
member to cancel or terminate his or her SGLI policy or issuing a life
insurance policy which replaces an existing SGLI policy unless the replacement
shall take effect upon or after the service member's separation from the
United States armed forces. (5) The following acts or
practices by an insurer and or insurance agent regarding disclosure are
declared to be false, misleading, deceptive or unfair: (a) Deploying, using or contracting for any lead generating
materials designed exclusively for use with service members that do not clearly
and conspicuously disclose that the recipient will be contacted by an insurance
agent, if that is the case, for the purpose of soliciting the purchase of life
insurance. (b) Failing to disclose that a solicitation for the sale of
life insurance will be made when establishing a specific appointment for an
in-person, face-to-face meeting with a prospective purchaser. (c) Excluding individually issued annuities, failing to
clearly and conspicuously disclose the fact that the product being sold is life
insurance. (d) Failing to make, at the time of sale or offer to an
individual known to be a service member, the written disclosures required by
section 10 of the "Military Personnel Financial Services Protection
Act," Pub. L. No. 109-290, p.16 or as amended. (e) Excluding individually issued annuities, when the sale
is conducted in-person face-to-face with an individual known to be a service
member, failing to provide the applicant at the time the application is
taken: (i) An explanation of any
free look period with instructions on how to cancel if a policy is issued;
and (ii) Either a copy of the
application or a written disclosure. The copy of the application or the written
disclosure shall clearly and concisely set out the type of life insurance, the
death benefit applied for and its expected first year cost. A basic
illustration that meets the requirements of rule 3901-6-04 of the
Administrative Code shall be deemed sufficient to meet this requirement for a
written disclosure. (6) The following acts or
practices by an insurer or insurance agent with respect to the sale of certain
life insurance products are declared to be false, misleading, deceptive or
unfair: (a) Excluding individually issued annuities, recommending
the purchase of any life insurance product, which includes a side fund, to a
service member in pay grades E-4 and below unless the insurer has reasonable
grounds for believing that the life insurance death benefit, standing alone, is
suitable. (b) Offering for sale or selling a life insurance product,
which includes a side fund, to a service member in pay grades E-4 and below who
is currently enrolled in SGLI, is presumed unsuitable unless, after the
completion of a needs assessment, the insurer demonstrates that the
applicant's SGLI death benefit, together with any other military survivor
benefits, savings and investments, survivor income, and other life insurance,
are insufficient to meet the applicant's insurable needs for life
insurance. (i) "Insurable
needs" are the risks associated with premature death taking into
consideration the financial obligations and immediate and future cash needs of
the applicant's estate and/or survivors or dependents. (ii) "Other military
survivor benefits" include, but are not limited to: the "Death
Gratuity," "Funeral Reimbursement," "Transition
Assistance," "Survivor and Dependents' Educational
Assistance," "Dependency and Indemnity Compensation," TRICARE
healthcare benefits, "Survivor Housing Benefits and Allowances,"
"Federal Income Tax Forgiveness," and "Social Security Survivor
Benefits." (c) Excluding individually issued annuities, offering for
sale or selling any life insurance contract which includes a side
fund: (i) Unless interest
credited accrues from the date of deposit to the date of withdrawal and permits
withdrawals without limit or penalty; (ii) Unless the applicant
has been provided with a schedule of effective rates of return based upon cash
flows of the combined product. For this disclosure, the effective rate of
return will consider all premiums and cash contributions made by the
policyholder and all cash accumulations and cash surrender values available to
the policyholder in addition to life insurance coverage. This schedule will be
provided for at least each policy year from one to ten and for every fifth
policy year thereafter, ending at age one hundred, policy maturity or final
expiration; and (iii) Which, by default,
diverts or transfers funds accumulated in the side fund to pay, reduce or
offset any premiums due. (d) Excluding individually issued annuities, offering for
sale or selling any life insurance contract which, after considering all policy
benefits, including but not limited to endowment, return of premium or
persistency, does not comply with standard nonforfeiture law for life
insurance. (e) Selling any life insurance product to an individual
known to be a service member that excludes coverage if the insured's death
is related to war, declared or undeclared, or any act related to military
service except for an accidental death coverage, e.g., double indemnity, which
may be excluded. (I) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated October 11, 2023 at 1:47 PM
|
Rule 3901-1-13 | Mortgage guaranty insurance.
Effective:
February 14, 2022
(A) Purpose The purpose of this rule is to implement division
(A)(24) of section 3929.01 of the Revised Code, as it pertains to the writing
and servicing of that kind of insurance known as mortgage guaranty insurance as
hereinafter defined. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under section 3901.041 of the Revised
Code. (C) Definitions The definitions set forth in this rule shall
govern the construction of the terms used in this rule: (1) "Mortgage
guaranty insurance" is: (a) Insurance against financial loss by reason of nonpayment of
principal, interest or other sums agreed to be paid under the terms of any note
or bond or other evidence of indebtedness secured by a mortgage, deed of trust,
or other instrument constituting a lien or charge on real estate, provided the
improvement on such real estate is a residential building or a condominium unit
or buildings designed for occupancy by not more than four families;
or (b) Insurance against financial loss by reason of nonpayment of
principal, interest or other sums agreed to be paid under the terms of any note
or bond or other evidence of indebtedness secured by a mortgage, deed of trust
or other instrument constituting a lien or charge on real estate, providing the
improvement on such real estate is a building or buildings designed for
occupancy by five or more families or designed to be occupied for industrial or
commercial purposes; or (c) Insurance against financial loss by reason of nonpayment of
rent or other sums agreed to be paid under the terms of a written lease for the
possession, use or occupancy of real estate, provided the improvement on such
real estate is a building or buildings designed to be occupied for industrial
or commercial purposes. (2) "Authorized real
estate security" for the purpose of this rule means a note, bond or other
evidence of indebtedness, not exceeding one-hundred and three per cent of the
lower of the fair value as fixed by appraisal or purchase price of the real
estate, secured by a mortgage, deed of trust, or other instrument which
constitutes, or is equivalent to, a first lien or charge on real estate,
provided: (a) Any percentage in excess of one-hundred per cent is used only
for closing costs. (b) The real estate loan secured in such manner is one of a type
which: (i) A bank, (ii) A building and loan
association, federal savings and loan, or a service corporation of either,
or (iii) An insurance
company, which is supervised and regulated by a department of the state of Ohio
or an agency of the federal government, is authorized to make, or would be
authorized to make, disregarding any requirement applicable to such an
institution that the amount of the loan not to exceed a certain percentage of
the value of the real estate. (c) The improvement on such real estate is a building or
buildings designed for occupancy as specified by paragraphs (C)(1)(a) and
(C)(1)(b) of this rule. (d) The lien on such real estate may be subject to and
subordinate to the following: (i) The lien on any
public bond, assessment or tax, when no installment, call or payment of or
under such bond, assessment or tax is delinquent. (ii) Outstanding mineral,
oil, water or timber rights, rights-of-way, easements or rights-of-way of
support, sewer rights, building restrictions or other restrictions or
covenants, conditions or regulations of use, or outstanding leases upon such
real property under which rents or profits are reserved to the owner
thereof. (3) "Contingency
reserve" means an additional premium reserve established to protect
policyholders against the effect of adverse economic cycles. (D) Capital and surplus A mortgage guaranty insurance company shall not
transact the business of mortgage guaranty insurance in the state of Ohio
unless: if a stock insurance company, it has capital and surplus in the
aggregate amount of not less than two million five hundred thousand dollars,
which aggregate shall include paid-in capital of not less than one million and
contributed surplus of not less than one million or if a mutual insurance
company, a minimum surplus of two million five hundred thousand dollars. (E) Limitations and restrictions on transacting
business (1) Mortgage guaranty
insurance may be transacted in this state by insurers fulfilling the
requirements of paragraph (E)(6) of this rule and holding a certificate of
authority for the transaction of such insurance pursuant to Title XXXIX of the
Revised Code and shall be written only to insure loans secured by authorized
real estate securities as defined in paragraph (C)(2) of this
rule. (2) Geographic
concentration (a) A mortgage guaranty insurance company shall not insure loans
secured by a single risk in excess of ten per cent of the company's
aggregate capital, surplus and contingency reserve. (b) No mortgage guaranty insurance company shall have more than
twenty per cent of its total insurance in force in any one metropolitan
statistical area ("MSA") as defined by the United States office of
management and budget. (3) Advertising No mortgage guaranty insurance company or any
agent or representative of a mortgage guaranty insurance company shall prepare
or distribute or assist in preparing or distributing any brochure, pamphlet,
report or any form of advertising to the effect that the real estate
investments of any financial institution are "insured investments,"
unless the brochure, pamphlet, report or advertising clearly states that the
loans are insured by mortgage guaranty insurance companies authorized to
transact the business of mortgage guaranty insurance in the state of Ohio or
are insured by an agency of the federal government, as the case may be. (4) Investment
limitation A mortgage guaranty insurance company shall not
invest in notes or other evidences of indebtedness secured by a mortgage or
other lien upon real property. This section shall not apply to obligations
secured by real property or contracts for the sale of real property, which
obligations or contracts of sale are acquired in the course of the good faith
settlement of claims under policies of insurance issued by the mortgage
guaranty insurance company, or in the good faith disposition of real property
so acquired. (5) Coverage
limitation (a) A mortgage guaranty insurance company shall limit its
coverage, with respect to any one authorized real estate security, net of
reinsurance, ceded to a reinsurer unaffiliated with the company or an
affiliated reinsurer which does not own, and is not owned by, in whole or in
part, the ceding mortgage guaranty insurer, to a maximum of twenty-five per
cent of the entire indebtedness to the insured under that authorized real
estate security. In lieu thereof, a mortgage guaranty insurance company may
elect to pay the entire indebtedness to the insured and acquire title to the
authorized real estate security. (b) The coverage limits set out in paragraph (E)(5)(a) of this
rule shall not apply to a mortgage guaranty insurance company that possesses
capital and surplus in excess of twenty-five million dollars. (6) Mortgage guaranty
insurance as monoline (a) A mortgage guaranty insurance company which anywhere
transacts any class of insurance other than mortgage guaranty insurance is not
eligible to transact mortgage guaranty insurance in the state of
Ohio. (b) A mortgage guaranty insurance company which anywhere
transacts the classes of insurance defined in paragraph (C)(1)(b) or (C)(1)(c)
of this rule may not transact in the state of Ohio the class of mortgage
guaranty insurance defined in paragraph (C)(1)(a) of this rule, provided,
however, a mortgage guaranty insurance company which transacts a class of
insurance defined in paragraph (C)(1)(a) of this rule may write up to five per
cent of its insurance in force on residential property designed for occupancy
by five or more families. (7) Underwriting
discrimination (a) Nothing in this rule shall be construed as limiting the right
of any mortgage guaranty insurance company to impose reasonable requirements
upon the lender with regard to the terms of any note or bond or other evidence
of indebtedness secured by a mortgage or deed of trust, such as requiring a
stipulated down payment by the borrower. (b) No mortgage guaranty insurance company may discriminate in
the issuance or extension of mortgage guaranty insurance on the basis of sex,
marital status, race, color, creed, national origin, physical handicap or
mental handicap. (c) No policy of mortgage guaranty insurance, excluding policies
of reinsurance, shall be written unless and until the insurer itself or the
lender, in compliance with underwriting directives from the insurer and subject
to periodic underwriting audits by the insurer, shall have conducted a
reasonable and thorough examination of the evidence supporting credit
worthiness of the borrower and the appraisal report reflecting market
evaluation of the property and shall have determined that prudent underwriting
standards have been met. (8) Policy forms and
premium rates filed (a) All policy forms and endorsements, and rates to be charged
and the premium including all modifications of rates and premiums to be paid by
the policyholder shall be filed with and subject to the provisions of sections
3937.01 to 3937.18 of the Revised Code. With respect to owner-occupied,
single-family dwellings or owner-occupied two family dwellings, the mortgage
guaranty insurance policy shall provide that the borrower shall not be liable
to the insurance company for any deficiency arising from a foreclosure
sale. (b) Every mortgage guaranty insurance company shall adopt, print
and make available a schedule of premium charges for mortgage guaranty
insurance policies. Premium charges made in conformity with the provisions of
this rule shall not be deemed to be of interest or other charges under any
other provision of law limiting interest or other charges in connection with
mortgage loans. The schedule shall show the entire amount of premium charge for
each type of mortgage guaranty insurance policy issued by the insurance
company. (9) Outstanding total
liability (a) A mortgage guaranty insurance company shall not at any time
have outstanding a total liability, net of reinsurance, under its aggregate
mortgage guaranty insurance policies exceeding twenty-five times its capital,
surplus and contingency reserve. In the event that any mortgage guaranty
insurance company has outstanding total liability exceeding twenty-five times
its capital, surplus and contingency reserve, it shall cease transacting new
mortgage guaranty business until such time as its total liability no longer
exceeds twenty-five times its capital, surplus and contingency
reserve. (b) The superintendent, in the superintendent's sole
discretion, may permit a temporary exception to the requirement set out in
paragraph (E)(9)(a) of this rule at the written request of a mortgage guaranty
insurer upon a finding that the mortgage guaranty insurer's policyholders
position is reasonable in relationship to the mortgage guaranty insurer's
aggregate insured risk and adequate to its financial needs. The request must be
made in writing at least ninety days in advance of the date that the mortgage
guaranty insurer expects to exceed the requirements of paragraph (E)(9)(a) of
this rule and shall, at a minimum, address the factors specified in paragraph
(E)(9)(c) of this rule, provided, however, that a mortgage guaranty insurance
company may submit a request for such exception within ten days after the
effective date of this rule as amended and shall be deemed to have complied
with the ninety day requirement in paragraph (E)(9)(b) of this
rule. (c) In determining whether a mortgage guaranty insurer's
policyholders position is reasonable in relation to the mortgage guaranty
insurer's aggregate insured risk and adequate to its financial needs, the
superintendent shall consider all of the following: (i) The size of the
mortgage guaranty insurer as measured by its assets, capital and surplus,
reserves, premium writings, insurance in force and other criteria as deemed
appropriate by the superintendent. (ii) The extent to which
the mortgage guaranty insurer's business is diversified across time,
geography, credit quality, origination, and distribution channels. (iii) The nature and
extent of the mortgage guaranty insurer's reinsurance
program. (iv) The quality,
diversification, and liquidity of the mortgage guaranty insurer's assets
and its investment portfolio. (v) The historical and
forecasted trend in the size of the mortgage guaranty insurer's
policyholder's position. (vi) The
policyholder's position maintained by other comparable mortgage guaranty
insurers in relation to the nature of their respective insured
risks. (vii) The adequacy of the
mortgage guaranty insurer's reserves. (viii) The quality and
liquidity of investments in affiliates. The superintendent may treat any such
investment as a non-admitted asset for purposes of determining the adequacy of
surplus as regards policyholders. (ix) The quality of the
mortgage guaranty insurer's earnings and the extent to which the reported
earnings of the mortgage guaranty insurer include extraordinary
items. (x) An independent
actuary's opinion as to the reasonableness and adequacy of the mortgage
guaranty insurer's historical and projected policyholder
position. (xi) The capital
contributions which have been infused or are available for future infusion into
the mortgage guaranty insurer. (xii) The historical and
projected trends in the components of the mortgage guaranty insurer's
aggregate insured risk, including, but not limited to, the quality and type of
the risks included in the aggregate insured risk. (d) The superintendent may retain accountants, actuaries, or
other experts to assist the superintendent in the review of the mortgage
guaranty insurer's request submitted pursuant to paragraph (E)(9)(b) of
this rule. The mortgage guaranty insurer shall bear the cost of retaining such
experts. (e) Any waiver shall be for a specified time, not to exceed two
years and shall be subject to any terms and conditions imposed by the
superintendent, in the superintendent's sole discretion. (10) High risk
underwriting Any mortgage guaranty insurance company which
receives five per cent or more of its net annual premium from policies written
to insure loans secured by authorized real estate securities having a greater
than ninety-five per cent loan-to-value ratio shall notify the superintendent
within thirty days. The superintendent may, if the superintendent finds that
further underwriting of loans having a greater than ninety-five per cent
loan-to-value ratio would have an adverse impact on the solvency of the
company, prohibit the company from further underwriting such loans. (F) Rebates, commissions, charges and conflict of
interest (1) Rebates, commissions
and charges (a) A mortgage guaranty insurance company shall not pay or cause
to be paid either directly or indirectly, to any owner, purchaser, lessor,
lessee, mortgagee or prospective mortgagee of the real property which secures
the authorized real estate security or which is the fee of an insured lease, or
any interest therein, or any person who is acting as an agent, representative,
attorney or employee of such owner, purchaser or mortgagee, any commission, or
any part of its premium charges or any other consideration as an inducement for
or as compensation on any mortgage guaranty insurance business. (b) In connection with the placement of any mortgage guaranty
insurance, a mortgage guaranty insurance company shall not cause or permit any
commission, fee, remuneration, or other compensation to be paid to, or received
by, any insured lender or lessor; any subsidiary or affiliate of any insured;
any officer, director or employee of any insured or any member of their
immediate family; any corporation, partnership, trust, trade association in
which any insured or any such officer, director, or employee or member of their
immediate family has a financial interest; or any designee, trust, nominee, or
other agent or representative of any of the foregoing. (c) No mortgage guaranty insurance company shall make any rebate
of any portion of the premium charge shown by the schedule required by
paragraph (E)(8)(b) of this rule. No mortgage guaranty insurance company shall
quote any rate or premium charge to any person which is different than that
currently available to others for the same type of coverage. The amount by
which any premium charge is less than that called for by the current schedule
of premium charges is an unlawful rebate. (2) Conflict of
interest (a) If a member of a holding company system, a mortgage guaranty
insurance company licensed to transact business in this state shall not
knowingly underwrite mortgage guaranty insurance on mortgages originated by the
holding company system or an affiliate or on mortgages originated by any
mortgage lender to which credit is extended, directly or indirectly, by the
holding company system or any affiliate unless such insurance is underwritten
on the same basis, for the same consideration and subject to the same
insurability requirements as insurance provided to nonaffiliated
lenders. (i) Any mortgage guaranty
insurance company which receives, in the aggregate, twenty per cent of more of
its net annual premium from policies written to insure mortgages originated by
affiliates in the holding company system shall, concurrent with the filing of
its annual statement, notify the superintendent of that fact. (ii) The superintendent
may, if the superintendent finds that further underwriting of policies issued
on said loans would have an adverse impact on the solvency of the company,
prohibit the mortgage guaranty insurance company for further underwriting such
loans. (b) A mortgage guaranty insurance company, the holding company
system of which it is a part or any affiliate shall not pay any commission,
remuneration, rebates or engage in activities proscribed in paragraph (F)(1) of
this rule. (G) Reserves (1) Unearned premium
reserves A mortgage guaranty insurance company shall
compute and maintain an unearned premium reserve as required by the
superintendent of insurance. (2) Loss
reserve A mortgage guaranty insurance company shall
compute and maintain adequate case basis and other loss reserves which
accurately reflect loss frequency and loss severity and shall include
components for claims reported and unpaid, and for claims incurred but not
reported, including estimated losses on: (a) Insured loans which have resulted in the conveyance of
property which remains unsold; (b) Insured loans in the process of foreclosure; (c) Insured loans in default for four months or for any lesser
period which is defined as default for such purposes in the policy provisions;
and (d) Insured leases in default for four months or for any lesser
period which is defined as default for such purposes in policy
provisions. (3) Contingency
reserve Each mortgage guaranty insurance company shall
establish a contingency reserve out of net premiums remaining (gross premiums
less premiums returned to policyholders net of reinsurance) after establishment
of the unearned premium reserve. The mortgage guaranty insurance company shall
contribute to the contingency reserve an amount equal to fifty per cent of such
remaining earned premiums. Contributions to the contingency reserve made during
each calendar year shall be maintained for a period of one hundred twenty
months, except that withdrawals may be made by the company in any year in which
the actual incurred losses exceed thirty-five per cent of the corresponding
earned premiums, and no such releases shall be made without prior approval by
the superintendent of the insurance company's state of domicile. If the
coverage provided in this rule exceeds the limitations set forth herein, the
superintendent of insurance shall establish a rate formula factor that will
produce a contingency reserve adequate for the added risk assumed. The face
amount of an insured mortgage shall be computed before any reduction by the
mortgage guaranty insurance company's election to limit its coverage to a
portion of the entire indebtedness. (H) Reinsurance Whenever a mortgage guaranty insurance company
obtains reinsurance from an insurance company which is properly licensed to
provide such reinsurance or from an appropriate governmental agency, the
mortgage guaranty insurer and the reinsurer shall establish and maintain the
reserves required in this rule in appropriate proportions in relation to the
risk retained by the original insurer and ceded to the assuming reinsurer so
that the total reserves established shall not be less than the reserves
required by this rule. (I) Miscellaneous (1) Whenever the laws of
any other jurisdiction in which a mortgage guaranty insurance company subject
to the requirement of this rule is also licensed to transact mortgage guaranty
insurance require a larger unearned premium reserve or contingency reserve in
the aggregate than that set forth herein, the establishment of such larger
unearned premium reserve or contingency reserve in the aggregate shall be
deemed to be in compliance with this rule. (2) Unearned premium
reserves and contingency reserves shall be computed and maintained on risks
insured after the effective date of this rule as required by paragraphs (G)(1)
and (G)(3) of this rule. Unearned premium reserves and contingency reserves on
risks insured before the effective date of this rule may be computed and
maintained as required previously. (J) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated February 14, 2022 at 8:54 AM
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Rule 3901-1-14 | Credit life and credit accident health insurance.
Effective:
November 16, 2023
(A) Purpose The purpose of this rule is to protect the interests of debtors and the public in Ohio by providing a framework for the transaction of credit life and credit accident and health insurance that ensures a complicated product is carefully and thoughtfully constructed and administered. (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 is issued pursuant to Chapter 3918. of the Revised Code regulating credit life insurance and credit accident and health insurance and is applicable to all policies, riders, applications for insurance, notices of proposed insurance, certificates of insurance and endorsements providing credit life insurance and credit accident and health insurance issued or renewed on or after November 1, 1983 in the state of Ohio. Certificates, notices of proposed insurance and premium rates applicable in connection with existing group policies of credit insurance are to be conformed to the requirements of this rule not later than the anniversary date of the group policy next following the effective date of this rule. No existing group credit life or group credit accident and health policy presently in force in Ohio will be rewritten or redated so as to delay or avoid the effect of this rule. Any policy issued to replace an existing policy of credit insurance or any amendment to any existing policy of credit insurance is to be ignored for the purpose of determining the anniversary if such change is made after July 1, 1983. (D) Filing and approval, disclosure Section 3918.07 of the Revised Code provides that all policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements and riders providing coverage on residents of Ohio are to be filed with the superintendent of insurance and that the superintendent may disapprove any such form. (1) No individual or group policy of credit life insurance or credit accident and health insurance including no application, binder, endorsement, rider, certificate of group insurance, notice of proposed insurance, or other form pertaining to credit life insurance or credit accident and health insurance under such policy are to be issued for delivery or used in this state, on or after the effective date of this rule unless such forms and the premium rates and refund formulas therefore have been filed with the superintendent of insurance and approved prior to such issuance or use and have not been subsequently disapproved in accordance with division (B) of section 3918.07 of the Revised Code. (2) If a group policy of credit life insurance or credit accident and health insurance: (a) Has been delivered in this state before the effective date of this rule, or (b) Delivered in another state before or after the effective date of this rule- The insurer is required to file only the group certificate and notice of proposed insurance as specified in divisions (B) and (D) of section 3918.06 of the Revised Code and such forms are to be approved by the superintendent if they conform with the requirements of Chapter 3918. of the Revised Code and this rule, and if the schedules of premium rates applicable to the insurance evidenced by such certificate or notice are not in excess of the standards set forth in this rule. Provided, however, the premium rate in effect on existing group policies may be continued until the first policy anniversary date following the effective date of this rule. (3) Division (D) of section 3918.06 of the Revised Code provides that the copy of the application for, or notice of, proposed insurance is separate and apart from the credit instrument unless the information required "is prominently set forth therein." The copy of the application for, or notice of, proposed insurance is deemed to be prominently set forth in the credit instrument if set forth in a separate provision on the face or reverse in type at least equal in size and prominence to the type used for the other provisions; provided that if the same is set forth on the reverse of the credit instrument, reference is to be made on the face of the instrument and provided further that the name of the debtor proposed for insurance, any figures relating to the amount and term of coverage, and the rate of amount of payment for insurance by the debtor need not be contained in a separate provision of the instrument, but may be set forth elsewhere in the instrument. (4) (a) The disclosure required by paragraph (D)(3) of this rule is to be made to the debtor at the time of the debtor's application for credit life or credit accident and health insurance (excluding non-contributory insurance) in connection with a credit transaction, and before the debtor becomes obligated to purchase such insurance. (b) The form(s) containing the disclosure are to be filed with the superintendent of insurance and the disclosure language is subject to disapproval pursuant to section 3918.07 of the Revised Code. (c) Additional disclosure is to be made using the exact form set forth in appendix I to this rule. (5) If a creditor makes available to the debtors, more than one plan of credit life insurance or more than one plan of credit accident and health insurance, all debtors must be informed of all such plans applicable to the type of loan. (E) Premium rate and coverage standards Where rate filings are made in accordance with the premium rate standards outlined in this paragraph of this rule, the filed rates equivalent to prima facie are deemed not to be excessive in relation to the benefits provided. (1) Standards for premium rates for credit life insurance (a) Monthly premium rate: It is presumed that the premium rate for credit life insurance, for which premiums are paid monthly on outstanding balances, is not excessive in relation to the benefits provided if the monthly premium rate for such coverage does not exceed 0.846 dollars per one thousand dollars of outstanding balance of insured indebtedness. (b) Prima facie single premium rate for decreasing term credit life insurance: It is presumed that the single premium rate for decreasing term credit life insurance for which premiums are paid in one sum for the entire duration of indebtedness, is not excessive in relation to the benefits provided if the single premium rate for such insurance does not exceed a rate of fifty-five cents per one hundred dollars repayable in twelve substantially equal monthly installments and, for other repayment periods, the equivalent single premium rates calculated according to the formula SPn = (n + 1)/20 times the monthly outstanding balance premium rate standard from paragraph (E)(1)(a) of this rule, where "n" is equal to the number of monthly payments, and "SPn" is the single premium rate per one hundred dollars repayable in "n" monthly installments. (c) As an alternative to the standards set forth above, an insurer may, where age data applicable to the insured persons are available, determine premium rates based on such age data and computed in a manner consistent herewith, subject to approval pursuant to section 3918.07 of the Revised Code. (d) Standards for premium rates for indebtedness repayable in installments other than as indicated in paragraph (E)(1) of this rule are to be the equivalent of these standards. (e) Other additional benefits to policyholders and their debtors, (i.e. dismemberment, partial disability, total and permanent disability, and suicide) may be provided by the insurance carriers if they so desire, but in no event may the charge for such coverage be passed on to the debtor so as to increase the total rate to exceed the rate established by this rule. If a suicide exclusion is utilized, such exclusion cannot be effective for more than six months following the effective date of coverage for that insured person. (f) The foregoing rate standards may be used for credit life insurance with or without age limitations. If an age limitation is provided, it may not be more restrictive than to exclude from coverage any debtor who has attained age sixty-five at incurral of indebtedness, or who will have attained age sixty-six at maturity of the indebtedness. (g) A policy provision that restricts coverage based on age in accordance with paragraph (E)(1)(c) or (E)(1)(f) of this rule, in the absence of misstatement, is valid only for the first sixty days of coverage. During the first sixty days of coverage the insurer has the right to cancel or restructure coverage that would otherwise provide benefits in excess of policy age restrictions. (h) These standards are applicable to the type of decreasing term credit life insurance contract customarily offered for sale protecting credit obligations repayable in substantially equal installments. Standards for premium rates in the case of forms which vary in any material respect from this standard type of credit insurance contract may reflect such variations to the extent that there is a measurable difference in the claims cost of the coverage provided and must receive approval pursuant to section 3918.07 of the Revised Code on a case basis. (i) Premium rates for joint credit life insurance are not to exceed one and three-quarters times the applicable single credit life rate. (j) Amount of credit life insurance: (i) In connection with loans or other credit transactions of sixty months or less, the amount of credit life insurance is not to exceed the scheduled or actual amount of indebtedness, whichever is greater. (ii) For loans or other credit transactions exceeding sixty months the amount of credit life insurance is not to exceed the net indebtedness, exclusive of unearned finance charges. (k) The foregoing standards for premium rates are those to become effective November 1, 1983. Effective May 1, 1985, the monthly outstanding balance premium rate is not to exceed eighty cents per one thousand dollars outstanding balance of insured indebtedness and the single premium rate for decreasing term credit life insurance for which premiums are paid in one sum for the entire duration of indebtedness is not to exceed fifty-two cents per one hundred dollars repayable in twelve substantially equal monthly installments. The superintendent is to use the experience data reported on the national association of insurance commissioners (NAIC) annual statement credit insurance experience exhibit to adjust the prima facie rates for credit life insurance on an industry-wide basis as necessary to establish and maintain a fifty per cent loss ratio. Prima facie rates are first to be adjusted in like manner effective November 1, 1986, based on the data reported the previous year, and adjusted in like manner effective November first of every year after 1986. However, after the November 1, 2013 adjustment, prima facie rates are to be adjusted in like manner effective January 1, 2017, based on the data reported for the previous three years, and be adjusted in like manner effective January first of every third year after two-thousand fourteen. (2) Standards for premium rates for credit accident and health insurance (a) If premiums are paid in one sum for the entire duration of the indebtedness the following rates per one hundred dollars of initial indebtedness repayable in the indicated number of equal monthly installments are applicable: Duration | Prima facie single premium rate/$100 14-day retroactive plan | Prima facie single premium rate/$100 14-day nonretroactive plan | 6 | $1.87 | $1.50 | 12 | 2.40 | 2.10 | 18 | 2.76 | 2.44 | 24 | 3.03 | 2.71 | 30 | 3.25 | 2.95 | 36 | 3.46 | 3.16 | 42 | 3.65 | 3.34 | 48 | 3.82 | 3.51 | 54 | 3.98 | 3.67 | 60 | 4.14 | 3.82 | 66 | 4.31 | 3.97 | 72 | 4.45 | 4.11 | 78 | 4.58 | 4.24 | 84 | 4.71 | 4.37 | 90 | 4.84 | 4.50 | 96 | 4.95 | 4.62 | 102 | 5.07 | 4.74 | 108 | 5.18 | 4.85 | 114 | 5.23 | 4.96 | 120 | 5.41 | 5.07 |
Duration | 30-day retroactive plan | 30-day nonretroactive plan | 6 | $1.28 | $ .74 | 12 | 1.81 | 1.27 | 18 | 2.04 | 1.62 | 24 | 2.20 | 1.82 | 30 | 2.34 | 1.96 | 36 | 2.47 | 2.08 | 42 | 2.57 | 2.19 | 48 | 2.67 | 2.28 | 54 | 2.77 | 2.38 | 60 | 2.85 | 2.47 | 66 | 2.95 | 2.55 | 72 | 3.04 | 2.63 | 78 | 3.11 | 2.70 | 84 | 3.19 | 2.78 | 90 | 3.26 | 2.85 | 96 | 3.33 | 2.92 | 102 | 3.39 | 2.98 | 108 | 3.46 | 3.06 | 114 | 3.52 | 3.11 | 120 | 3.59 | 3.18 |
Effective May 1, 1985, the one sum premium per one hundred dollars of initial indebtedness is to be one hundred three per cent of the rates listed in this paragraph of this rule. The superintendent is to use the experience data reported on the national association of insurance commissioners (NAIC) annual statement credit insurance experience exhibit to adjust the prima facie rates for credit accident and health insurance on an industry-wide basis as necessary to establish and maintain a sixty per cent loss ratio. Prima facie rates are to first be adjusted in like manner effective November 1, 1986, based on data reported the previous year, and are to be adjusted in like manner effective November first, of every year after 1986. However, after the November 1, 2013 adjustment, prima facie rates are to be adjusted in like manner effective January 1, 2017, based on the data reported for the previous three years, and adjusted in like manner effective January first of every third year after two-thousand fourteen. The above shows rates only for credit transactions repayable in a total number of installments which is a multiple of six. For transactions repayable in numbers of installments not set forth above; either the actuarial equivalent or straight-line interpolation may be utilized. The rate standards set forth above are to be applicable for such contracts which contain a provision excluding or denying claim for disability resulting from pre-existing illness, disease or physical condition (whether or not by name or specific description) which totally disabled the debtor at any time during the six-month period immediately preceding the effective date of the debtor's coverage, or provisions which exclude coverage for pre-existing conditions for which the insured debtor received medical advice, diagnosis, or treatment within six months preceding the effective date of the debtor's coverage, and which caused loss within the six months following the effective date of coverage, but contain no other provision which excludes or restricts liability in the event of disability. The rate standards set forth herein may be increased ten per cent for such contracts that do not contain a provision excluding or denying a claim for disability resulting from pre-existing conditions. Any contract to which the above rates apply may contain provisions excluding or restricting coverage in the event of pregnancy, intentionally self-inflicted injuries, foreign travel or residence, or flight in non-scheduled aircraft, war or military service. Any contract may also provide an age limitation, which limitation may not be more restrictive than to exclude from coverage any debtor who has attained age sixty-five at incurral of indebtedness, or who will have attained age sixty-six at maturity of the indebtedness. No contract is to provide for an actively-at-work test that requires the debtor to be employed more than thirty hours per week. (b) Standards for premium rates for indebtedness repayable in installments other than as indicated in paragraph (E)(2)(a) of this rule are to be the equivalent of the standards. (c) If premium rates are payable other than in one sum, an insurer may determine such rates on a basis consistent with the rates set forth in paragraph (E)(2)(a) of this rule. (d) The standard for premium rates set forth in paragraph (E)(2)(a) of this rule is applicable to the form of credit accident and health insurance described which is illustrative of the kind of coverage that may be issued. This rule, however, does not preclude an insurer from filing other forms of credit accident and health insurance for consideration by the superintendent. (e) Standards for premium rates for contracts providing benefits on a basis different from those illustrated above are to be the equivalent of the standard. (f) A policy provision that restricts coverage based on age in accordance with paragraph (E)(2)(a) of this rule, in the absence of misstatement, is to be valid only for the first sixty days of coverage. During the first sixty days of coverage the insurer has the right to cancel or restructure coverage that would otherwise provide benefits in excess of policy restrictions. (3) Combination coverage Standards for premium rates for contracts combining credit life and credit accident and health coverage in one policy are to be consistent with the standards set forth in paragraphs (E)(1) and (E)(2) of this rule, however, such contracts must provide for a refund of the unearned credit accident and health premium, in the event of the debtor's death. Refunds are computed from the date of death. These refunds are also to be provided when the insured debtor is covered by separate contracts providing credit life and credit accident and health coverage. (4) Loss ratio adjustments Notwithstanding any other provision or paragraph of this rule to the contrary, the superintendent of insurance may, after November 1, 1986, establish minimum loss ratio percentage requirements, based upon claim experience and expense factors, that differ from the fifty per cent standard for credit life and sixty per cent standard for credit accident and health coverage set forth in paragraphs (E)(1), (E)(2), and (E)(8) of this rule. After November 1, 1986, any insurer desiring to show cause why its premium rates for a case or class of business should not be reduced, as set forth in paragraphs (E)(1) and (E)(8) of this rule, must agree to an examination and audit of it's claim experience and expense factors. The examination and audit will be performed by qualified actuaries and accountants selected by the superintendent of insurance. The expense of the examination and audit will be paid for by the insurer and the insurer must agree to accept the findings of the superintendent of insurance which will be based upon the results of the examination and audit. (5) Definitions As used in connection with credit life or accident and health insurance, the following terms mean: (a) "Claims" means benefits payable on death or disability and does not include loss adjustment expense, claim settlement expense or any other expense, charge, cost or payment. (b) "Claims incurred" means claims actually paid during the year, plus any estimated reserves at the end of the year for reported claims in the process of settlement, and reserves for unreported claims, and less any estimated reserves at the end of the preceding year for reported claims in the process of settlement and for unreported claims. (c) Premiums earned Where premiums are payable monthly based on the outstanding balance of insured indebtedness, "premiums earned" means the total premiums paid the insurer during the reporting year plus premiums due the insurer but unpaid at the end of the preceding year, less the premiums due the insurer but unpaid at the end of the current year. Where premiums are payable in one sum for the entire duration of indebtedness, "premiums earned" means the one-sum premiums which become due the insurer during the reporting year, plus the reserve at the beginning of the reporting year minus the reserve at the end of the reporting year. The premiums as defined under either system of premium payments are without reduction of any kind except for premiums refunded or adjusted on account of termination of coverage. (d) "Class of business" means a grouping of businesses under the following categories, each category being referred to as a class of business: (i) Credit unions; (ii) Commercial banks, societies for savings, and savings and loan associations; (iii) Finance companies (including second mortgage lenders); (iv) Motor vehicle dealers under retail installment sale contracts; (v) All other sales finance companies (including dealers under retail installment sale contracts); (vi) Production credit associations; (vii) All others. (6) Life premium rate deviations Credit life insurance premium rates exceeding the standards in paragraph (E)(1) of this rule may be approved, as not being excessive in relation to the benefits provided, for the insurance covering the debtors of a creditor or a class of business hereinafter called the "case," if the credible loss ratio for the case is more than sixty per cent. For such cases, the permissible premium rate is to be computed as follows, unless otherwise determined by the superintendent. (a) Determine the credible monthly claim cost by multiplying the monthly outstanding balance prima facie premium rate of 0.846 dollars per one thousand dollars by the case credible loss ratio obtained in paragraph (E)(6)(e)(iii) of this rule. (b) The permissible deviated outstanding balance rate is equal to the credible monthly claim cost plus 0.338 dollars per one thousand dollars. (c) If the case is on the single premium basis, the permissible schedule of single premium rates is obtained using the formula SPn = (n + 1)/20 times the deviated monthly outstanding balance rate from paragraph (E)(6)(b) of this rule, where: "n" = the number of equal monthly payments. "SPn" = the single premium rate per one hundred dollars for "n" monthly payments. (d) The monthly outstanding balance prima facie premium rate of 0.846 dollars per one thousand dollars indicated in paragraph (E)(6)(a) of this rule, will reduce to eighty cents per one thousand dollars on May 1, 1985. The 0.338 dollars per one thousand dollars loading factor indicated in paragraph (E)(6)(b) of this rule, will reduce to thirty-two cents on May 1, 1985. On November 1, 1986 the monthly outstanding balance prima facie premium rate in paragraph (E)(6)(a) of this rule will be the rate required by paragraph (E)(1)(k) of this rule and the loading factor in paragraph (E)(6)(b) of this rule will be forty per cent of the outstanding balance rate. (e) The credible loss ratio is computed as follows: (i) Case size and credibility Credibility of experience depends upon the case size. Case size is measured according to three premium size brackets to reflect the greater credibility of experience resulting from greater size. The premiums in the brackets are the premiums based on the prima facie premium rate standard. The size brackets are: Case size | Earned premium | 1 | $ 50,000 - 200,000 | 2 | 200,000 - 500,000 | 3 | 500,000 - and over |
(ii) Credible experience period The credible experience period is three years if the case aggregate earned premium based on the prima facie rate, developed during the most recent three-year period is less than five hundred thousand dollars. If the case aggregate earned premium during the most recent three-year period based on the prima facie rate is equal to or greater than five hundred thousand dollars, then the credible experience period is the most recent number of years needed to accumulate five hundred thousand dollars of premium on the prima facie rate. For example, if a case were of sufficient size to generate at least five hundred thousand dollars in one year, the credible experience period would be one year. The experience used in determining the permissible rate is the experience during the credible experience period, as follows: (iii) Credible loss ratio The credible loss ratio is based on the experience of the credible experience period. It is a composite of the case's actual loss ratio (ALR) during the credible experience period and the basic loss ratio (BLR) contemplated by the prima facie rate standards which is fifty per cent for credit life insurance. The actual loss ratio is the ratio of the incurred claims of the credible experience period divided by the earned premium based on the prima facie rate during the credible experience period. The compositing of the actual and basic loss ratios takes account of fluctuations about expected experience, and dampens the effect of non-credible fluctuations. The factors used in compositing the loss ratios depend upon case size in accordance with the three size brackets in paragraph (E)(6)(e)(i) of this rule, as follows: Case size | Credible loss ratio | 1 | 50% of ALR plus 50% of BLR | 2 | 75% of ALR plus 25% of BLR | 3 | 100% of ALR plus 0% of BLR |
(7) Accident and health premium rate deviations Credit accident and health insurance premium rates exceeding the standards in paragraph (E)(2) of this rule may be approved, as not being excessive in relation to the benefits provided, for the insurance covering the debtors of a creditor or a class of business hereinafter called the "case," if the credible loss ratio for the case is more than sixty per cent. For such cases, the permissible premium rate is to be computed as follows, unless otherwise determined by the superintendent. (a) Determine the credible claim cost by multiplying the prima facie premium rate, by the case credible loss ratio, obtained in paragraph (E)(7)(c)(iii) of this rule. (b) The permissible deviated outstanding balance rate is equal to the credible monthly claim cost plus the loading factor. The loading factor is computed as a percentage of the prima facie rate as adjusted in accordance with the following table: (i) Effective November 1, 1983 - thirty-five per cent times the prima facie rate set forth in paragraph (E)(2)(a) of this rule; (ii) Effective May 1, 1985 - thirty-seven per cent times the prima facie rate set forth in paragraph (E)(2)(a) of this rule; (iii) Effective November 1, 1986 - forty per cent times the prima facie rate set forth in paragraph (E)(2)(a) of this rule. (c) The credible loss ratio is computed as follows: (i) Case size and credibility Credibility of experience depends upon the case size. Case size is measured according to three premium size brackets to reflect the greater credibility of experience resulting from greater size. The premiums in the brackets are the premiums based on the prima facie premium rate standard. The size brackets are: Case size | Earned premium | 1 | $ 50,000 - 200,000 | 2 | 200,000 - 500,000 | 3 | 500,000 - and over |
(ii) Credible experience period The credible experience period is three years if the case aggregate earned premium based on the prima facie rate, developed during the most recent three-year period is less than five hundred thousand dollars. If the case aggregate earned premium during the most recent three-year period based on the prima facie rate is equal to or greater than five hundred thousand dollars then the credible experience period is the most recent number of years needed to accumulate five hundred thousand dollars of premium on the prima facie rate. For example, if a case were of sufficient size to generate at least five hundred thousand dollars in one year, the credible experience period would be one year. (iii) Credible loss ratio The credible loss ratio is based on the experience of the credible experience period. It is a composite of the case's actual loss ratio (ALR) during the credible experience period and the basic loss ratio (BLR) contemplated by the prima facie rate standards which is sixty per cent for credit accident and health insurance. The actual loss ratio is the ratio of the incurred claims of the credible experience period divided by the earned premium based on the prima facie rate during the credible experience period. The compositing of the actual and basic loss ratios takes account of fluctuations about expected experience, and dampens the effect of non-credible fluctuations. The factors used in compositing the loss ratios depend upon case size in accordance with the three size brackets in paragraph (E)(7)(c)(i) of this rule, as follows: Case size | Credible loss ratio | 1 | 50% of ALR plus 50% of BLR | 2 | 75% of ALR plus 25% of BLR | 3 | 100% of ALR plus 0% of BLR |
(8) Required downward rate deviations After November 1, 1986, any insurer which produces, for a case or class of business, as determined by the insurer, a credible loss ratio of less than fifty per cent for life and sixty per cent for accident and health, is required to make appropriate rate reductions or show cause why its premium rates for such case or class of business should not be reduced. When the rate for any case is required to be reduced, such reduction is to continue whether the case remains with the insurer or is transferred to another insurer, until the loss experience demonstrates that the reduction is no longer appropriate. (9) Cases with no identifiable charge Where no debtor of a case is paying directly or indirectly any part of the premium, the case rates are such reasonable rates as are approved by the superintendent. (10) Approved rates No insurer, commencing with the policy anniversary date on or after the effective date of this rule, is to charge a premium rate for credit life or credit health and accident insurance insuring a debtor under an existing group policy of credit life or accident and health insurance at a rate greater than that approved for the insurer under this rule, or a premium rate under a group policy of credit life or credit accident and health insurance for any renewal year greater than the rate approved pursuant to this rule. (11) Time limit on deviations Premium rate deviations as outlined in paragraph (E)(6) of this rule may be utilized for a period of time not to exceed the credible experience period or two years, whichever is less. All rates in excess of those outlined in this rule are withdrawn as of the effective date of this rule except that any rate provided under a policy of group credit life insurance or group credit accident and health insurance heretofore approved by the department of insurance in excess of those prescribed herein may be continued until the first anniversary date of such group policy after the effective date of this rule. Such rate may be thereafter continued only if an application for increase in premium rates is approved with respect thereto. (12) Charges for credit insurance It will be considered that the debtor is charged a specific amount for insurance if, among other things: (a) An identifiable amount for insurance is disclosed in the credit or other instrument furnished the debtor which sets out the financial elements of the credit transaction, or (b) There is a differential in finance, interest, service or other similar charge rates charged to debtors who, except for their insurance status (insured vs. non-insured), are in like circumstances. (F) Termination of coverage and refunds (1) If a debtor is covered by a group credit insurance policy providing for the payment of single premiums to the insurer, then provision is to be made by the insurer that in the event of termination of the master policy for any reason, insurance coverage with respect to any debtor insured under such master policy shall be continued for the entire period for which the single premium has been paid, subject to the debtor's right to cancel the insurance at any time by express action. (2) If a debtor is covered by a group credit insurance policy providing for payment of premiums to the insurer on a monthly outstanding balance basis, then the group policy is to provide that, in the event of termination of the policy for whatever reason, the insured debtor is to be notified that coverage will continue for thirty days from the date of notice, except where replacement of the coverage by the same or another insurer in the same or greater amount takes place without lapse of coverage. The notice required in this paragraph is to be given by the insurer or, at the option of the insurer, by the creditor. (3) Refunds. (a) Section 3918.08 of the Revised Code requires refund formulas to be filed and approved by the superintendent. This requirement will be considered satisfied if the refund formula to be applied by the insurer is set forth in either the policy if the coverage is written on an individual policy basis, or the certificate if the coverage is written on a group basis pursuant to a master policy; provided further that such forms of policies and certificates have not been disapproved by the superintendent. In the event that the refund formula to be used is the "sum of digits" also commonly known as the "rule of 78" it will be sufficient to state either descriptive name without further explanation in the provisions of the policy or certificate. (b) The refund of premiums in case of reducing term credit life insurance or credit health and accident insurance on which premiums are payable other than by a single premium and of level-term credit life insurance is to be equal to the pro rata unearned gross premium, and in the case of reducing term credit life insurance paid by a single premium and of credit accident and health insurance is to be equal to the amount computed by the "sum of digits" formula commonly known as the "rule of 78." (c) The refund of the amount charged to or collected from the debtor for insurance in the case of reducing term credit life insurance or credit accident and health insurance where said amount, if payable other than in a single sum and of level-term credit life insurance, is to be equal to the pro rata unearned gross amount to be collected, and in the case of reducing term credit life insurance where the whole amount thereof is charged to or collected from the debtor in a single sum and of credit accident and health insurance shall be equal to the amount computed by the "sum of digits" formula commonly known as the "rule of 78." (d) Notwithstanding paragraph (F)(3)(a), (F)(3)(b), or (F)(3)(c) of this rule, the refund of premiums for credit accident and health insurance where the premiums are payable in a single sum, and for credit life insurance where the premiums are payable in a single sum and the amount of life insurance does not exceed the net indebtedness, is to be equal to the single premium that would be charged for the remaining term of the debt for the balance outstanding at the date of refund. This formula is commonly known as the "rule of anticipation." (e) No refund or credit need be made if the amount is less than one dollar. (f) In the event of termination, no charge for coverage may be made for the first fifteen days of a loan month, and a full month may be charged for sixteen days or more of a loan month. (G) Maintenance of statistics (1) Each insurer writing credit life insurance and credit accident and health insurance is to maintain statistics, on a policy-year basis for group policies, and on a calendar-year basis for individual policies with respect to each plan or type of coverage showing, on an accrual basis, separately for credit life insurance and separately for direct business and reinsurance assumed with respect to the following: (a) Gross premiums received. (b) Refunds of premiums on terminated insurance. (c) Increase in unearned premium reserve. (d) Earned premiums. (e) Claims paid. (f) Increase in claim reserve. (g) Claims incurred. (h) Reserve increases other than set forth in paragraphs (G)(1)(c) and (G)(1)(f) of this rule. (i) Commissions. (j) Fees and other allowances. (k) Dividends and experience rating refunds. (l) Mean amount of life insurance in force. (m) Mean number of individual policies and certificates in force during the calendar year. (2) With respect to credit accident and health insurance, each insurer is to keep a record for each plan or type of coverage which, in addition to the above statistics, shows the nature of the benefits payable, the applicable waiting period, and the rate at which premiums are charged therefor. (3) Credit insurance data and statistics are to be submitted from time to time as requested by the superintendent of insurance. (H) Responsibility of insurers with respect to creditors (1) Each insurer transacting credit insurance is responsible to conduct a thorough review of each creditor with respect to the first year of business with such creditor. The insurer thereafter is to conduct such reviews as reasonably may be necessary to assure compliance with applicable statutes and rules. (2) Such reviews are to include, but not by way of limitation, verification that: (a) Premiums and charges to debtors are properly calculated and transmitted to the insurer, based on rates permitted under statutes and the superintendent's rules and on the amounts of indebtedness actually insured; and (b) Claims are refunds are properly calculated and paid; (c) Disclosure forms are distributed before the debtor becomes obligated to purchase insurance. (3) An insurer's responsibilities are not discharged or avoided by the delegation of premium collection or refund calculation or check or draft drawing, and the actions of such delegatee will be considered as the acts of the insurer. The insurer is to maintain records of such reviews for three years, and such records will be subject to call and review by the superintendent at his discretion. (I) Reserve basis (1) Life (a) For credit insurance written prior to January 1, 2009, in the state of Ohio, all insurers will be required to maintain reserves not less than 1958 "CET Table of Mortality" at four and one-half per cent interest. (b) For credit insurance written on or after January 1, 2009, in the state of Ohio, all insurers will be required to maintain reserves not less than "2001 Male Composite Ultimate CSO Mortality" at the maximum valuation interest rate for life insurance as defined in section 3903.721 of the Revised Code. (c) When the credit life insurance policy or certificate insures two lives, the minimum standard is to be twice the mortality in the "2001 CSO Male Composite Ultimate Mortality" table based on the age of the older insured. (d) In addition to the mortality reserve, the extra liability for refunds is to be established and maintained as part of the total reserve. Any reserve basis which in the aggregate equals or produces a greater reserve not less than this basis will be acceptable to the superintendent. Also, proper rate credit and similar reserves approved by the superintendent are to be carried by the companies on such risks. (2) Accident and health (a) For credit insurance written prior to January 1, 2009, the reserve must not be less than a reserve based on the 1964 "Commissioner's disability table" at three per cent annual interest. However, should an insurer, after establishing a credit disability reserve on the 1964 "Commissioner's disability table", develop a disability reserve for such disability policies that is less than the premium that would have been charged for the remaining benefits for the balance of the term, then an additional reserve must be established so that such aggregate total is not less than the premium that would have been charged for the remaining benefits for the balance of the term, for such disability policies. The mean of the gross unearned premiums calculated on a "rule of 78" and a pro rata basis is deemed to meet the requirements of this provision. (b) For credit insurance written on or after January 1, 2009, the reserve must not be less than a reserve based on the morbidity assumption as described in paragraph (I)(2)(c) of this rule at the maximum valuation interest rate for ordinary life insurance as defined in section 3903.721 of the Revised Code. However, should an insurer, after establishing a credit disability reserve on the 1985 "CIDA Table", develop a disability reserve for such disability policies that is less than the premium that would have been charged for the remaining benefits for the balance of the term, then an additional reserve must be established so that such aggregate total is not less than the premium that would have been charged for the remaining benefits for the balance of the term, for such disability policies. The mean of the gross unearned premiums calculated on the "rule of 78" and a pro rata basis is deemed to meet the requirements of this provision. (c) The morbidity assumption for use in determining the minimum standard for valuation of single premium credit disability insurance contract reserves are: (i) For plans having fewer than a fifteen day elimination period, the "1985 Commissioners Individual Disability Table A" (85CIDA) with claim incidence rates increased by twelve per cent; or (ii) For plans having greater than a fourteen day elimination period, the 85CIDA for a fourteen-day elimination period with claim incidence rates increased by twelve per cent. (J) Severability If any portion of this rule or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the rule or related rules which can be given effect without the invalid portion or application, and to this end the provisions of this rule are severable.
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Last updated November 16, 2023 at 8:29 AM
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Rule 3901-1-18 | Ohio fair plan - plan of operation.
Effective:
November 17, 2022
(A) Purpose The purpose of this rule is for adoption by the
superintendent of a plan of operation submitted by the board of governors of
the "Ohio Fair Plan Underwriting Association". The plan of operation
has been formulated for the purpose of making basic property and
homeowners' insurance coverage, as identified in section 3929.42 of the
Revised Code, available for qualified property owned by persons who have been
unable to secure such insurance in the normal insurance market. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under section 3901.041 of the Revised
Code. This plan of operation is adopted pursuant to section 3929.43 of the
Revised Code and implements sections 3929.41 to 3929.49 of the Revised
Code. (C) Definitions (1) "Association" means the "Ohio Fair Plan
Underwriting Association" created under section 3929.43 of the Revised
Code. (2) "Basic property
insurance" means insurance against direct loss to property as defined and
limited in standard fire policies and extended coverage endorsements thereon,
as approved by the superintendent, and insurance for such types, classes and
locations of property against the perils of vandalism, malicious mischief,
burglary, theft or liability, as the superintendent shall designate. The
association is also authorized to provide insurance against the perils of
burglary, robbery, and theft for properties. Such coverage is to be provided by
separate policies. Basic property insurance does not include automobile
insurance or insurance on manufacturing risks. (3) "Environmental
hazard" means any hazardous condition that might give rise to loss under
an insurance contract, but which is beyond the control of the property
owner. (4) "Insurable
risks" means property that meets the reasonable underwriting standards of
the association. (5) "Underwriting
standards" means the underwriting standards for basic property insurance
and homeowners' insurance which have been filed with the
superintendent. (6) "Homeowners' insurance" means insurance on
owner-occupied dwellings providing personal multi-peril property and liability
coverages, commonly known as homeowners' insurance, subject to
underwriting standards, exclusions, deductibles, rates and conditions as are
customarily used by member insurers for similar coverages. (7) "Location"
means real and personal property consisting of and contained in a single
building or in contiguous buildings under one ownership. (8) "Urban
area" means the state of Ohio having been so designated by the
superintendent. (9) "Superintendent" means the superintendent of
insurance of the state of Ohio. (10) "Member
insurer" means an insurer required to be a member of the association by
section 3929.43 of the Revised Code. (11) "Licensed
agent" means any person licensed by the superintendent pursuant to section
3905.01 of the Revised Code. (12) "Board"
means the board of governors of the association authorized pursuant to section
3929.43 of the Revised Code. (13) "Applicant" means any person applying for insurance
from the association. (D) Notice of cancellation by members Member insurers shall provide written notice of
cancellation or nonrenewal for any risk eligible for insurance through the
association, (except for non-payment of premium, evidence of incendiarism, or
misrepresentation) not less than thirty days prior to cancellation or
nonrenewal. The notice shall explain to the insured the procedures for making
application to the association. This thirty-day notice shall not apply to
binders of thirty days duration or less. (E) Insurance agents (1) Upon request, a
licensed agent shall assist any owner of property in completing an application
for insurance with the association. (2) No licensed agent,
although licensed to represent one or more member insurers of the association,
shall hold himself out as an agent of the association or have any authority to
bind any risk for the association. (F) Maximum liability, limitations and special
coverage (1) The maximum limits of
liability for basic property insurance and homeowners' insurance per
location through the association is one million five hundred thousand dollars.
The maximum limit of liability for residential crime insurance is ten thousand
dollars. The maximum limit of liability for commercial crime insurance is
fifteen thousand dollars. (2) The association may
require that vandalism and malicious mischief coverage be written in
conjunction with extended coverage. (3) The association is
authorized to issue mine subsidence insurance coverage to its policyholders
pursuant to sections 3929.50 to 3929.61 of the Revised Code and as provided for
in the plan of operations of the "Mine Subsidence Insurance Underwriting
Association." (4) The association is
not authorized to provide insurance coverage for automobiles or manufacturing
risks. (G) Inspections (1) Any person having an
insurable interest in real or tangible personal property, or both, at a fixed
location in Ohio, who has been unable to obtain basic property insurance or
homeowners' insurance, shall be granted upon application to the
association, an inspection of the property. The inspection shall be made only
of property requiring an inspection to determine eligibility for fair plan
coverage. The inspection shall be free of charge to the applicant. (2) All inspection
reports shall be in writing and shall contain the information necessary to
determine eligibility for coverage pursuant to the association's
underwriting guide as filed with the superintendent. (3) If an interior
inspection is necessary to determine eligibility of property described in an
application submitted to the association: (a) The inspector or inspection company shall contact the new
applicant and arrange for the applicant or the person designated by the
applicant to be present during the inspection. The inspector shall not
recommend correction of physical deficiencies or advise the applicant whether
the association will provide coverage. The inspection report shall provide any
information necessary for underwriting but shall not refer to environmental
hazards. Physical deficiencies shall be reported on the inspection report.
Vacancy or unoccupancy shall be reported on the inspection report. (b) The inspection report shall contain information describing
the occupancy and other observations of the risk. (4) Subsequent to the
inspection of a property, the association shall indicate to the new applicant
any condition charges which have been applied by the association. (5) After the inspection
report has been completed, a copy of the completed inspection report, and any
photograph, indicating the pertinent features of the building, maintenance, and
occupancy shall be sent within ten days to the association. (6) The association
shall, within ten business days after receipt of the inspection report, advise
the applicant and his licensed agent that: (a) The risk is acceptable, and if condition charges have been
imposed, the improvements necessary to remove the condition charges;
or (b) The risk will be acceptable if the improvements noted in the
report are made by the applicant; or (c) The risk is not acceptable for the reasons stated in the
report. (7) The association shall
not refuse to insure any risk because of an environmental hazard. (8) The association may,
for cause upon information or well-founded belief without notice to the insured
at any time during the policy term, cause a property insured by it to be
inspected for the purpose of determining whether the property meets the
association's underwriting standards. Reinspections may also be made upon
the request of the insured, for statistical purposes, upon change in type of
occupancy, or upon a reasonable periodic schedule. The association may, upon
the basis of the report of reinspection, refuse to renew or may cancel a policy
in accordance with its terms and this plan of operation. Any person aggrieved
by such decision may appeal, in accordance with paragraph (J) of this rule. The
association need not afford an insured the opportunity to be present during a
reinspection nor furnish the insured with a copy of a reinspection report. If
an insured requests a copy of a reinspection report, the association shall
provide a copy to the insured. (9) If an inspection
report shows that a property is in violation of any building, housing, air
pollution, sanitation, health, fire or safety code, ordinance or rule, or if an
applicant otherwise has received written notice of any violation of such a
code, ordinance of rule, the applicant shall also submit to the association a
detailed plan that indicates the manner and estimated period of time in which
violation will be corrected. If the association is satisfied that the
violations are subject to correction within a reasonable period of time and
that the applicant otherwise meets the requirements of section 3929.44 of the
Revised Code, it may issue a policy or binder to the applicant on the condition
that the plan be implemented and completed on schedule and that the property be
reinspected. (H) Application and issuance of policy (1) Every policy written
by the association shall include an additional policy condition representing
that: (a) At least two insurance companies authorized to do business in
Ohio have declined to grant the coverage requested in the application;
and (b) There are no outstanding taxes, assessments, penalties or
charges with respect to the property to be insured; and (c) The applicant has not received written notice from an
authorized public entity stating that his property is in violation of any
building, housing, air pollution, sanitation, health, fire or safety code,
ordinance or rule. (2) If the property is in
violation of any such code, ordinance or rule, and if the applicant has
received such written notice of any such violation, the applicant shall submit
to the association a detailed plan that indicates the manner and estimated
period of time in which such violations will be corrected. If the association
is satisfied that the violations are subject to correction within a reasonable
period of time and that the applicant otherwise meets the requirements of
section 3929.44 of the Revised Code, it may cause a policy or binder of basic
property insurance to be issued to the applicant on the condition that the plan
be implemented on schedule and that the property be reinspected. (3) The association is
under no obligation to issue basic property insurance or homeowners insurance
to any person, unless that person and his or her property would be insurable in
the normal insurance market, and such property, except for its location, would
constitute an insurable risk in accordance with reasonable underwriting
standards. The association, in determining whether the property is insurable,
shall give no consideration to the condition of surrounding property or
properties, where such condition is not within the control of the
applicant. (4) If a risk is accepted
by the association, it shall deliver a policy or binder to the applicant and if
applicable, the licensed insurance agent, upon payment of the premium to the
association. The association shall pay the authorized commission to the
licensed agent as designated by the applicant. The association shall not pay
commission to a nonresident agent. The association may pay commission to a
licensed nonresident business entity agent for assistance provided by an
individual resident agent affiliated with that nonresident business entity
agent. (5) The association, upon
receipt of the applicable premium from the applicant, shall issue the policy to
be effective the day following receipt of the premium. The policy shall be
issued in the name of the association as provided in section 3929.481 of the
Revised Code. (6) The policy shall be
issued for a term of one year. (7) If the property is
found to be an insurable risk but the inspection reveals that there are one or
more unsatisfactory conditions, charges will be imposed in conformity with the
rating plans on file with the superintendent. If the unsatisfactory conditions
are corrected, and such corrections are verified, the charges shall be
revised. (8) If the association
determines that the property is not an acceptable risk, the association shall,
within ten days, send the applicant a written statement setting forth in
reasonable detail the features of the property or conditions which prevent it
from constituting an acceptable risk and the corrections to be made in order to
make the property an acceptable risk. (9) Upon completion of
the required corrections by the applicant, the association, when notified,
shall promptly reinspect the property, if such reinspection is necessary to
determine eligibility. (I) Binders (1) Each application
shall clearly indicate the availability of a binder to an
applicant. (2) A binder shall be
issued to the applicant upon payment to the association of the minimum binder
deposit premium and provided the application indicates that the risk
preliminarily meets the association's underwriting standards. The earliest
a binder shall be effective is at one minute after twelve a.m. the day
following receipt of the premium and completed application by the
association. (3) If inspection is
impossible through no fault of the inspection company, the association may
decline to offer coverage until such time as the property becomes available for
inspection. (4) The binder shall
remain in effect until the risk is accepted by the association or until
cancelled and the reasons for cancellation given to the applicant. (5) Binders shall be
issued for a definite period, not to exceed one year. (6) (a) If an insurance policy is to be issued, the policy shall
commence on the effective date of the binder. Policies so issued are not
subject to flat cancellation. (b) If an insurance policy will not be issued, the full earned
premium must be charged subject to the rules governing cancellation of
policies. (c) A binder shall be void upon the acceptance of a risk by the
association and the payment of any additional premium indicated by an
inspection; or upon the cancellation of a risk and notice of reasons for the
cancellation given to the applicant. (7) (a) The association shall not cancel a policy or binder issued by
it, except: (i) For cause, which
would have been grounds for nonacceptance of the risk had such cause been known
to the association at the time of acceptance; or (ii) For nonpayment;
or (iii) At the request of
an insured. (b) Notice of cancellation, together with the reasons therefore,
shall be sent to the insured. (c) Any cancellation notice to an insured shall be accompanied by
a statement that the insured has a right to appeal as provided in paragraph (J)
of this rule. (8) If a property meets
all underwriting requirements, the association shall compute the actual annual
premium from rates approved by the superintendent of insurance pursuant to
Chapter 3935. of the Revised Code. A return premium will be forwarded to the
applicant if the provisional binder premium exceeds the actual annual premium.
The association shall request additional premium if the actual annual premium
exceeds the estimated provisional binder premium. (9) If a property does
not meet all underwriting requirements, the association shall cancel the binder
on a pro rata basis. If an applicant requests cancellation of a binder, the
association shall cancel in accordance with cancellation provisions of the
coverage forms approved by the superintendent. (J) Right to appeal (1) Any applicant or
insured shall have the right to appeal any action or decision of the
association to the board of the association. Such appeal to the board must be
made in writing within thirty days after receipt of notice of the action or
decision of the association. Within forty-five days from receipt of an appeal,
the board, upon no less than ten days notice to the insured, shall hold a
hearing on the appeal. For good cause shown, by the insured or the association,
the hearing may be continued for not more than sixty days. The board shall
render its decision on the appeal and notify the applicant or insured of its
decision no later than ten days after the hearing. Each denial of insurance to
an applicant shall be accompanied by a statement to the applicant and the
licensed agent that the applicant has the right to appeal. (2) Any applicant,
insured, or member insurer shall have the right to appeal to the superintendent
any action or decision of the board. An appeal shall be made within thirty days
of the board's action or decision. The decision of the superintendent of
an appeal is a final order and is subject to judicial review as provided in
Chapter 119. of the Revised Code. (K) Indemnification Each member of any association committee, each
association officer, employee, or member insurer, and each member of the board
shall be indemnified against liability incurred in connection with the affairs
of the association. The conditions and limits of such indemnification are
provided in "Article IX of the Constitution," "Articles of
Agreement" and "Bylaws of the Association." (L) Fidelity coverage The association shall obtain fidelity coverage to
reimburse the association for any pecuniary loss it may sustain by any act or
acts of fraud or dishonesty on the part of members of the board, association
officers or employees in the discharge of their duties. (M) Board of governors (1) The association shall
be governed by a board. (2) The board shall meet
as often as may be required to perform the general duties of administration of
the association or on the call of the superintendent. Seven members of the
board shall constitute a quorum. (3) The board shall
appoint a general manager as administrator who shall serve at the pleasure of
the board and perform such duties as the board designates. (4) The board may
promulgate guidelines consistent with state law and the plan of operation to
govern such internal operations as investments, personnel, underwriting
standards and claims practices. The guidelines shall be in writing and filed
with the superintendent. (5) The board shall
undertake a public education program to assure that the services of the
association receive adequate public attention. In accordance with division (I)
of section 3929.43 of the Revised Code, the board shall adopt a written program
for decreasing the overall utilization of the association as a source of
insurance. (N) Standing committees The board may appoint committees as it deems
necessary to carry out the purpose and operations of the association. (O) Relationship with member insurers (1) The association shall
operate as a joint underwriting association insuring one hundred per cent of
the risk on behalf of its member insurers. It may cede or purchase reinsurance
in the name of the association or on behalf of member insurers on eligible
risks written through the association. (2) Each member insurer
shall participate in the writings, expenses, assessments, profits and losses of
the association in the same proportion as a member insurer's premiums
written bear to the aggregate premiums written by all member insurers as
determined by the board. (3) There shall be an
annual meeting of the association and its member insurers at a time and place
fixed by the superintendent. Representatives of member insurers on the board
shall serve for a period of one year or until successors are elected or
designated. (4) A special meeting may
be called at such time and place designated by the superintendent or upon the
written request to the superintendent. (5) Twenty days notice of
an annual or special meeting shall be given in writing by the board to member
insurers. A majority of member insurers present at a meeting shall constitute a
quorum. Voting by proxy shall be permitted. Notice of any meeting shall be
accompanied by an agenda for the meeting. (6) Any matter may be
proposed and voted upon by regular mail, email or other electronic means
provided such procedure is unanimously authorized by the members of the board
present and voting at any meeting of the board. If so approved by the board,
notice of any proposal shall be mailed to member insurers not less than twenty
days prior to the final date fixed by the board for voting
thereon. (7) At any regular or
special meeting at which the vote of member insurers is or may be required on
any proposal, or any vote of member insurers which may be taken by regular
mail, email or other electronic means on any proposal, votes shall be cast and
counted on a weighted basis in accordance with each member insurer's
respective habitational or commercial premiums written, as the case may
be. (P) Member insolvency (1) In the event any
member insurer fails to pay the assessment for its proportionate part of any
loss or expense because the member insurer is insolvent, and the board
determines that the assessment cannot be collected within a reasonable period
of time, the unpaid assessment shall be paid by the remaining member insurers,
each contributing in the manner provided by division (E) of section 3929.43 of
the Revised Code, but without regard to the premium writings of the insolvent
member insurer. The insolvent member insurer shall remain liable to the
association for the full amount of the assessment and any collection made by
the association against the assessment shall be credited and paid back to the
other member insurers in the same proportions as shall have been utilized in
calculating each member insurer's contribution toward the unpaid
assessment. (2) No refund which would
otherwise be paid under the plan of operation shall be paid to a member when
its membership has been terminated, or to the liquidator, receiver,
conservator, or statutory successor of a member insurer until the assessment of
the member insurer has been paid. A refund shall be applied as a set-off
against an assessment. Any balance remaining shall be paid to the member
insurer or to the liquidator, receiver, conservator, or statutory successor of
the member insurer. (Q) Advance assessments and recoupments (1) At such times as may
be determined by the board and approved by the superintendent, the board shall
establish an annual rate of assessment needed to cover any deficit arising out
of the operation of the association. The rate of assessment shall be based upon
a reasonable estimate of a deficit expected to occur. The association may levy
advance assessments at that rate against member insurers, payable in periodic
installments, subject to approval by the superintendent. (2) The board may at any
time levy an assessment against member insurers to provide necessary operating
funds. (3) Each member insurer
may recoup assessments levied against it by adjusting its premiums for basic
property insurance and homeowner's insurance by the addition of a rating
factor computed from time to time by the board and approved by the
superintendent. The board shall notify all member insurers of the amount of the
rating factor and any changes to it. (4) Any member insurer
implementing a change in rates pursuant to division (D)(2) of section 3929.43
of the Revised Code, shall file the change with the superintendent. The change
shall not increase rates more than the amount authorized by the association and
approved by the superintendent pursuant to the plan. (R) Reinsurance No reinsurance plan or proposal of the
association shall be implemented prior to being filed with the
superintendent. (S) Statistics (1) Every insurance
policy issued by the association shall be separately coded for statistical
purposes. (2) The association shall
comply with any reporting requirements of the superintendent in respect of its
underwriting operations and experience. The reports shall be made at least
annually in such form and detail as may be required by the superintendent under
section 3935.03 of the Revised Code. (3) The association shall
report its loss and expense experience to a statistical organization approved
by the superintendent. Its loss and expense experience shall be reported in a
form and according to a plan filed by the statistical organization with the
superintendent. (4) The association shall
submit to the superintendent periodic reports concerning the number of risks
inspected, the number of risks accepted, the number of risks conditionally
accepted, the number of reinspections made and the number of risks
declined. (T) Distribution of associated funds Ten days prior to the distribution to its member
insurers of any funds held by the association, notification shall be given to
the superintendent. (U) Filing of policies and other documents All policies, endorsements, forms, manual rates
or rating plans, minimum class rates, rating schedules, rating rules, and every
modification of the same shall be those filed with the superintendent. The
association may file special notice endorsements for review by the
superintendent. In the event that the superintendent approves a rating factor
under paragraph (Q)(3) of this rule, such increment shall be applicable to all
policies issued by the association. (V) Annual and quarterly financial statements The association shall file annual and quarterly
financial statements with the superintendent in the form prescribed by the
superintendent. Annual financial statements shall be prepared and furnished to
the superintendent on or before March first of the following year. (W) Examination of books and records The superintendent or any person designated by
the superintendent may examine the operation of the association in accordance
with section 3929.45 of the Revised Code. The expenses of the examination shall
be paid by the association. (X) Investments The association shall invest its funds in
accordance with section 3925.08 of the Revised Code. (Y) General powers of superintendent (1) The plan of operation
and any amendment thereto shall be subject to the approval of the
superintendent and adopted pursuant to Chapter 119. of the Revised
Code. (2) The plan of operation
shall be administered under the supervision of the superintendent. (3) The association shall
submit to the superintendent periodic reports as the superintendent deems
necessary. (Z) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated November 17, 2022 at 8:52 AM
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Rule 3901-1-22 | Risk modification plans.
Effective:
November 17, 2022
(A) Purpose The purpose of this rule is to set forth the
requirements of risk modification plans that are permitted for non-personal
lines insurance to recognize variation in hazard and characteristics of
risk. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under section 3901.041 of the Revised
Code, which requires the superintendent to adopt, amend, and rescind rules and
make adjudications necessary to discharge duties and exercise powers provided
to the superintendent under Title XXXIX of the Revised Code, subject to
sections 119.01 to 119.13 of the Revised Code. This rule is issued to implement
sections 3935.03, 3935.04, 3937.02 and 3937.03 of the Revised Code. (C) Definitions (1) "Risk
modification plan" (commonly called a schedule rating plan or an
individual risk premium modification plan) means the application of judgment
debits or credits to the otherwise applicable premium, which are based upon the
individual risk's variation in hazard and characteristics of the risk
otherwise not reflected. (2) "Experience
modification plan" means any rating plan or procedure, including a
retrospective rating plan wherein a manual rate for insurance is modified based
upon the past loss experience of the insured. (3) "Expense
modification plan" means any rating plan or procedure where the variation
of the premium for a particular risk corresponds to the variation in the
expenses of this particular risk from those contemplated in the manual rate for
insurance. (4) "Personal
lines" means a policy of property and casualty insurance issued to a
natural person primarily for personal or family protection, such as a personal
automobile, homeowners, non-commercial dwelling fire or personal umbrella
policy. (D) Specifications Every filing for a risk modification plan must
contain satisfactory specifications of factors or elements to be applied. The
risk modification plan shall not duplicate any factor or element already fully
reflected in the basic premium or rates. (E) Eligibility criteria Every filing for a risk modification plan shall
indicate any eligibility criteria, including, but not limited to, any minimum
premium criteria that the insurer utilizes to determine if the risk
modification plan should be applied to a particular risk. A risk modification
plan must be applied to all eligible risks. (F) Maximum debit and credit A limit of twenty-five per cent maximum debit and
credit shall be applied to the premium or rate based on the application of a
risk modification plan. This limitation does not apply to any debit or credit
applied to the premium or rate based on the application of an experience
modification plan or an expense modification plan. (G) Documentation Each company shall obtain all information
necessary to determine the proper application of the risk modification plan to
any particular risk. Each company shall maintain adequate supporting
information for inspection by the superintendent of insurance, upon request,
for a period of not less than three years. (H) Applicability This rule is not applicable to any risk written
by an insurer in accordance with divisions (F) and (G) of section 3935.04 of
the Revised Code. This rule is not applicable for any risk written by an
insurer in accordance with divisions (E), (F), and (G) of section 3937.03 of
the Revised Code. (I) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms or provisions shall be and continue in full force
and effect.
Last updated November 17, 2022 at 8:52 AM
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Rule 3901-1-23 | Inland marine risks.
Effective:
November 16, 2017
(A) Purpose The purpose of this rule is to define what
constitutes an inland marine risk. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under section 3901.041 of the Revised
Code. (C) Inland marine risks (1) Inland marine risks
shall be established by the nation-wide inland marine definition, approved and
recommended by the "National Association of Insurance Commissioners"
on December 9, 1976. (2) Any company wishing
to deviate from the nation-wide inland marine definition shall make a formal
filing and obtain approval of the superintendent of insurance before using such
deviation. (D) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated October 11, 2023 at 1:47 PM
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Rule 3901-1-24 | Public insurance adjusters.
Effective:
February 14, 2022
(A) Purpose The purpose of this rule is to safeguard the
interest of the public by regulating the conduct of public insurance
adjusters. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under Chapter 3951. and section 3901.041
of the Revised Code. (C) Prohibited activities No public insurance adjuster or public insurance
adjuster agent shall: (1) Engage in any manner
or degree, for compensation of any kind, in the business of repairing,
remodeling, or replacing damaged or destroyed property, real or personal, which
damage or destruction is covered by a policy of insurance; nor have any direct
or indirect interest in, nor receive compensation of any kind from any person,
firm, association, partnership, or corporation which is engaged in such
business; (2) Attempt in any manner
to solicit a loss during the progress of a fire or while the fire department or
any of its representatives are in any manner engaged at the damaged premises;
nor in any way interfere with the performance of the duties of an investigator
of the state fire marshal's office, an investigator of any fire
department, or a law enforcement official of this state or of any political
subdivision thereof; (3) Give or offer to give
to an insured or that person's representative any portion of the
adjuster's fee or anticipated settlement of the claim for loss or damage
as an inducement to secure a contract for the adjustment of a
loss; (4) Represent that public
insurance adjuster to be an adjuster for or a representative of any insurance
company, a fire investigator, or a person connected with any fire department or
law enforcement agency; (5) Compensate any person
to act on that person's behalf in the solicitation, negotiation, or
settlement of a claim unless such person is licensed as a public insurance
adjuster or a public insurance adjuster agent; (6) Make an inventory or
estimate of loss or damage other than that which is fair and honest;
and (7) Own or acquire any
direct or indirect financial interest in any property, real or personal, which
is the subject of a loss adjusted by that public insurance adjuster; nor have
any direct or indirect financial interest in the sale of any salvage of any
property which is the subject of a loss adjusted by that public insurance
adjuster. (D) Records of adjuster Every public insurance adjuster shall keep a full
record of that perons's transactions as an adjuster for the previous three
years and such records shall be open at all times to the inspection of the
superintendent of insurance or the superintendent's representative. Such
records shall show for each loss adjusted by the public insurance
adjuster: (1) The name of the
insured; (2) The date, location,
and the public insurance adjuster's estimate of the amount of
loss; (3) The name of the
insurer or insurers which issued any policy covering the loss which was the
subject of the adjustment; (4) The amount of
coverage, the expiration date, and the number of each policy of insurance
covering such loss; (5) An itemized statement
of all recoveries by the insured from all sources with regard to such
loss; (6) The names and
addresses of any person or persons soliciting the adjustment on behalf of the
public insurance adjuster and the date and time when solicited; (7) The total
compensation received by the public insurance adjuster for the adjustment of
the loss; (8) Copies of any
agreements between the public insurance adjuster and the insured;
and (9) Names and addresses
of all contractors who performed or contracted to perform work of any kind on
the damaged or destroyed property prior to settlement of the
claim. (E) Contract requirements (1) No public insurance
adjuster shall use in that person's business as a public insurance
adjuster a contract whereby an insured engages or employs the public insurance
adjuster to perform the functions specified in division (A) of section 3951.01
of the Revised Code until thirty days after the form of such contract has been
filed with the superintendent of insurance, unless within such time the
superintendent gives the public insurance adjuster written approval for the use
of such form. If the superintendent finds within such thirty-day period that
the form filed contains any language which is prohibited by any law of this
state, including any rule of the superintendent, or that it is inconsistent,
ambiguous, misleading, deceptive, or likely to mislead an insured, the
superintendent will give written notice of such finding to the public insurance
adjuster who filed the form, and the public insurance adjuster shall thereafter
not use such form. (2) Every such contract
must conspicuously set out the fee of the public insurance adjuster for the
adjustment services to be rendered the insured pursuant to the
contract. (F) Restriction on insurers (1) No insurer authorized
to issue the types of insurance policies set forth in division (B) of section
3951.01 of the Revised Code shall: (a) Recognize a public insurance adjuster as a party interested
in the proceeds of any insurance settlements arising from such policies or
negotiate an insurance settlement with a public insurance adjuster representing
an insured unless such public insurance adjuster has been duly licensed as a
public insurance adjuster by the department of insurance. (b) Negotiate an insurance settlement with a representative of an
insured, other than a licensed public insurance adjuster, unless such
representative has been duly appointed as such by a court of law or is one of
those persons enumerated in division (E) of section 3951.01 of the Revised
Code. (2) Each insurance
company referred to in paragraph (F)(1) of this rule shall keep a record of
each insurance loss and/or settlement wherein the insured was represented by a
public insurance adjuster. Such record shall include a copy of the public
insurance adjuster's certificate of authority. (G) Suspension or revocation The superintendent of insurance may suspend,
revoke, or refuse to renew the license of a public insurance adjuster or public
insurance adjuster agent found to be in violation of this rule. Such
suspension, revocation, or refusal to renew shall be in addition to, not a
substitution for, the penalties provided in section 3951.99 of the Revised
Code. (H) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated February 14, 2022 at 8:54 AM
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Rule 3901-1-31 | Group insurance regulations.
Effective:
November 16, 2017
(A) Purpose The purpose of this rule is to provide for the
writing of policies of group insurance, on a limited basis as hereinafter
outlined, by an insurance company having a certificate of authority pursuant to
the second paragraph of section 3941.02 of the Revised Code and to ensure that
residents of Ohio are not precluded from having group insurance where
advantageous tax attributes may be applicable. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under section 3901.041 of the Revised
Code. (C) Prohibitions No insurance company shall issue any group policy
with respect to any kind of insurance subject to either Chapter 3935. or 3937.
of the Revised Code unless: (1) It is a kind of
insurance which, if issued to an employer, would permit the employer's
contributions, if any, to be deductible by the employer and to be excluded from
the gross income of the employees, their spouses, and dependents under the
applicable provisions of the Internal Revenue Code of 1986; and (2) It is a kind of
insurance which the insurance company is authorized to transact pursuant to its
certificate of authority. (D) Eligible groups Any kind of insurance which meets the
requirements of paragraph (C) of this rule may be written by issuing a group
policy to: (1) Any employer;
or (2) Any association,
including a labor union, which has a constitution and by-laws and which has
been organized and is maintained in good faith for purposes other than that of
obtaining insurance; or (3) Any other
substantially similar group which, in the discretion of the superintendent of
insurance, may be subject to the issuance of a group policy. Such group policy shall be for the benefit of
the employees or members of the insured group, including their dependents or
members of their immediate families if they are included in the
coverage. (E) Filings Any filing made by an insurance company
pertaining to a group policy authorized by this rule shall comply with and be
subject to the provisions of either Chapter 3935. or 3937. of the Revised Code,
whichever is applicable to the kind of insurance being written, and shall
include an individual certificate, to be delivered to each employee or member
of the insured group, setting forth in summary form a statement of the
essential features of the insurance coverage of such employees or members, the
insurance coverage of their dependents or members of their immediate families
if they are included in the coverage, and to whom benefits thereunder are
payable. Rates shall not be deemed to be unfairly discriminatory because
different premiums result from differences in either or both loss exposures and
expense factors, so long as the rates reflect the differences with reasonable
accuracy. (F) Agents No person shall act as an insurance agent in the
solicitation or issuance of a group policy authorized by this rule unless such
person is duly licensed as an agent for that kind of insurance under the
applicable sections of the Revised Code. (G) Inland marine risks This rule shall not be applicable to the writing
of inland marine insurance. (H) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated October 11, 2023 at 1:48 PM
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Rule 3901-1-48 | "Ohio mine subsidence insurance underwriting association" and "mine subsidence insurance fund" plan of operation.
Effective:
February 14, 2022
(A) Purpose The purpose of this rule is to implement sections
3929.50 to 3929.53 and 3929.55 to 3929.56 and 3929.58 to 3929.61 of the Revised
Code which: (1) Establishes the
"Ohio Mine Subsidence Underwriting Association," (2) Provides for the
transfer of risk from member insurers to the association, and (3) Creates the
"Mine Subsidence Insurance Fund." (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) "Basic property
insurance" means insurance against direct loss to property as defined and
limited in dwelling fire, homeowners, and farm policies and extended coverage
endorsements thereon, and insurance for such types, classes and locations of
property against the perils of vandalism, malicious mischief, burglary or
theft, as the superintendent of insurance shall designate. (2) "Board"
means the four-member board of governors, empowered by division (C) of section
3929.51 of the Revised Code to govern the "Ohio Mine Subsidence Insurance
Underwriting Association" and the "Ohio Mine Subsidence Insurance
Fund." (3) "Homeowners
insurance" means insurance on owner-occupied dwellings providing personal
multi-peril property and liability coverages, commonly known as
"homeowners insurance." (4) "Farm
insurance" means insurance providing property coverage on farm dwelling
buildings. (5) "Dwelling fire
insurance" means a policy providing property coverage on residential
buildings for the perils of fire and lightning and additional
coverages. (6) "Member" means all insurers
authorized to write and engaged in writing within the state, on a direct basis,
basic property insurance or any component thereof in multi-peril and
policies. (7) "Mine subsidence" means
loss caused by the collapse or lateral or vertical movement of structures
resulting from the caving in of underground mines, including coal mines, clay
mines, limestone mines, and salt mines. Mine subsidence does not include loss
caused by earthquakes, landslide, volcanic eruption, or collapse of strip
mines, storm and sewer drains or rapid transit tunnels. (8) "Mine subsidence
coverage" means the limits and type of coverage as defined by the mine
subsidence insurance governing board in the coverage form and approved by the
superintendent. (9) "Mine Subsidence Insurance
Underwriting Association," hereinafter referred to as
"association" means the association of members formed pursuant to
section 3929.51 of the Revised Code. (10) "Mine Subsidence Insurance
Fund," hereinafter referred to as "fund," means the fund formed
pursuant to section 3929.52 of the Revised Code which is administered by the
board for the purpose of making available insurance coverage against mine
subsidence. The state treasurer is the custodian of the fund. (11) "Plan of operation,"
hereinafter referred to as "plan," means the plan of operation
approved by the superintendent for the economical, fair and nondiscriminatory
administration of the requirements identified in sections 3929.50 to 3929.53
and 3929.55 to 3929.56 and 3929.58 to 3929.61 of the Revised Code. (12) "Strip mines" means any
surface mine. (13) "Structure" means any one
to four-family dwelling as defined and limited in dwelling fire, homeowners,
and farm policies and other structures as described, defined, or limited in the
mine subsidence insurance form. (14) "Superintendent" means the
superintendent of insurance of the state of Ohio. (15) "Treasurer" means the
treasurer of the state of Ohio. (16) "Auditor" means the auditor
of the state of Ohio. (D) Board of governors (1) The association and
fund shall be administered by the board consisting of the director of natural
resources or the director's designee, as chairperson, the treasurer of the
state or the treasurer of state's designee, and one representative from
member companies. The representative from the member companies shall be an
Ohio-domiciled member of the association. (2) The board shall
approve all actions of the association, have the responsibility of
administering the association and fund. (3) The board shall meet
as often as is required to perform the duties of administration, and shall meet
upon the request of any single member of the board. In no event shall the board
meet less than two times per year. (E) Meeting of members (1) Members shall elect
their authorized representative every three years. The member company
representative elected to the board shall be an Ohio-domiciled
company. (2) The members may hold
meetings as needed and during any such meeting, a quorum shall consist of a
simple majority of members present. (3) Each member shall be
entitled to one vote. Members in the same group of insurers shall be entitled
to one vote only. (F) Liability Every policy of mine subsidence insurance written
hereunder shall provide that such policy does not create any liability on the
part of the member issuing such policy, the association, or any organization
with which it may contract for administrative or claims services, beyond the
net premium on such policies paid into the fund. Such policies shall create no
liability beyond the amounts in the fund, on the part of the state of Ohio, the
"Ohio Insurance Guaranty Association" and its member companies or any
other person or organization. (G) Notice of availability of mine
subsidence insurance (1) Every insurer that
offers basic property and homeowners insurance insuring on a direct basis a
structure located in the counties of Athens, Belmont, Carroll, Columbiana,
Coshocton, Gallia, Guernsey, Harrison, Hocking, Holmes, Jackson, Jefferson,
Lawrence, Mahoning, Meigs, Monroe, Morgan, Muskingum, Noble, Perry, Scioto,
Stark, Trumbull, Tuscarawas, Vinton and Washington shall include mine
subsidence coverage provided by the Ohio mine subsidence insurance underwriting
association in each policy of basic property and homeowners insurance that is
delivered, issued for delivery or renewed in any of such counties. (2) The mine subsidence
insurance governing board herein designates Delaware, Erie, Geauga, Lake,
Licking, Medina, Ottawa, Portage, Preble, Summit and Wayne counties as counties
in which mine subsidence coverage must be offered, on an optional basis, by an
insurer. (a) Every insurer that offers basic property and homeowners
insurance insuring on a direct basis to a structure located in any county
designated in paragraph (G)(2) of this rule shall offer to include, on an
optional basis, mine subsidence coverage provided by the association in each
policy of basic property insurance that is delivered, issued for delivery, or
renewed in any such designated county. (b) This offer shall contain language and be in a form approved
by the superintendent which includes a description of mine subsidence coverage,
a statement that the purchase of the coverage is optional, and the premium
charged for the coverage. (H) Application for coverage A member insurer who receives a request from a
named insured or applicant for mine subsidence shall forward to that named
insured or applicant an application for mine subsidence coverage. Such
application may be included, at the insurer's option, with the offer
described in paragraph (G)(2)(a) of this rule. The form of the application
shall be approved by the superintendent. (I) Administration and claims
processing The board may retain a contractor to provide
administrative and claims processing. When a contractor is retained, the board
may from time to time review: (1) The performance of
the contractor; (2) The procedures and
standards used by the contractor for administration and claims processing;
and (3) The application of
those procedures and standards to applicants for insurance and to claims of
insureds. (J) Underwriting (1) Mine subsidence
coverage will be available on eligible property. Eligible property must
be: (a) A structure as defined in this rule; (b) Covered by a valid basic property or homeowners insurance
policy. (2) The member may refuse
to provide mine subsidence coverage on an otherwise eligible property
where: (a) The structure evidences un-repaired subsidence damage;
or (b) The structure evidences any mine subsidence damage in
progress. (3) The limit of
liability for direct loss caused by mine subsidence under this plan of
operation shall not exceed an amount equal to the coverage on the dwelling
provided by a basic property or homeowners policy, or three hundred thousand
dollars, whichever is less, and shall not exceed the amount expressed in the
mine subsidence coverage form as approved by the mine subsidence insurance
governing board and approved by the superintendent of insurance. (4) All coverage provided
pursuant to this plan of operation is subject to a deductible as expressed in
the mine subsidence coverage form as approved by the mine subsidence insurance
governing board and approved by the superintendent of insurance, but at no time
shall the deductible be less than two hundred fifty dollars, or more than five
hundred dollars. (K) Rates and forms (1) Rates. The board
shall periodically review the premium level and experience data and recommend
to the superintendent a rate or schedule of rates sufficient to
satisfy: (a) All foreseeable claims; (b) Normal cost of operation; and (c) A reserve for unexpected contingencies. However, the premium level for mine subsidence
coverage in a county designated for optional coverage shall not exceed an
annual rate that is greater than twenty dollars. The premium level for mine
subsidence coverage in a county as designated in paragraph (G)(1) of this rule
shall not exceed an annual rate that is greater than five dollars. (2) Forms. The policy
forms and language shall be approved by the superintendent. (L) Audits The auditor shall audit the affairs of the fund
in accordance with section 3929.55 of the Revised Code at least once each year.
The auditor shall ascertain the expenses incurred in making any such audit and
shall certify the amount to the board for payment from the fund. (M) Reporting and statistics (1) Claim reports.
Members shall, upon receipt of notice of claims from policyholder(s), confirm
coverage and provide formal notice of claim to the association. (2) Financial
reports: (a) The fiscal period shall be the calendar year. (b) Members reports are required quarterly and shall be due on
the forty-fifth day following the close of the quarter. (c) Members' reports shall be in forms approved by the board
and shall include, at minimum: (i) Gross written premium
on a per county basis. (ii) Premium
cancelled/returned on a per county basis. (iii) Ceding commission
withheld (for optional counties only). (d) Members reports shall be accompanied by the appropriate
remittance which shall be full premium collected for mine subsidence coverage
in the counties denoted in paragraph (G)(1) of this rule and the net premium
(gross premium written, less ceding commission) in the counties denoted in
paragraph (G)(2) of this rule less any cancellation/returns. In the event a
balance is due to the insurer, that balance shall be carried forward as a
credit against future written premiums. An insurer may apply for a refund only
if it ceases to issue basic property or homeowner insurance
coverage. (e) Members shall report and pay premium taxes as
required. (f) The association shall review, verify and reconcile
members' reports and research, and rectify any
inconsistencies. (g) The association shall remit receipts to the fund, said
remittance to be supported by a summary report of premium written,
cancelled/non-renewed, net premium written and commission taken. (3) Statistical reports.
Members shall compile and file, on a quarterly basis with the financial
reports, a summary report of statistics in a form approved by the board. Such
reports shall, at minimum, contain: (a) Quarter and year-to-date policy count by county and in
total; (b) Quarter and year-to-date premium written by
county. (N) "Mine Subsidence Insurance
Fund" The fund shall receive all revenues,
appropriations and investment earnings pursuant to this plan of operation.
Premiums collected will be considered program income in accordance with the
uniform administrative requirements for grants to state and local governments
and be used: (1) To enable the fund to
be self-sustaining, with the fund invested by the treasurer of state under
guidelines established by the board; (2) To provide a reserve
for payment of claims for verified claims from all types of mine subsidence,
including non-coal mining, post-1977 underground mines and active underground
mines; (O) Investment of custodial
funds With the approval of the board, the treasurer of
state may invest any monies in the fund that are in excess of the amounts
required to meet the immediate cash needs and operating expenses of the fund.
The board shall not provide guidelines for the investment of excess funds that
are broader or more liberal than the investment provisions for property
casualty insurance companies set forth in Chapter 3925. of the Revised
Code. (P) Reinsurance agreement (1) Every insurer
authorized and engaged in writing on a direct basis any property coverages in
the state of Ohio shall execute a reinsurance agreement with the association.
The form of the reinsurance agreement shall be in a form approved by the
board. (2) An insurer may
request exemption from the requirements of paragraph (P) of this rule by filing
the exemption form with the superintendent. The exemption shall be effective
after review and approved by the superintendent of insurance. (3) Any insurer who has
received an exemption shall notify the association of any change in any
circumstances that would be reason to revoke the exemption. (Q) Effective date of the
plan This plan of operation shall be effective upon
the effective date of this rule. (R) Amendments Amendments to the plan may be requested by the
board or superintendent of insurance in accordance with the provisions of
section 3929.53 of the Revised Code. (S) Meeting notice (1) The board and each of
its committees and subcommittees shall provide notice of regular, special, and
emergency meetings as the same are scheduled by posting the dates, times,
locations, and agendas (if applicable) on the board's official web
site. (2) The board maintains a
list of individuals who have requested individual notice of each meeting.
Individual notice may be given via mail, electronic mail, or
facsimile. (a) Any person who desires individual mail notice of the meetings
described in paragraph (S)(1) of this rule shall make the request in writing to
the board at its business address. The board may refuse to honor a request for
individual mail notice unless the person requesting such notice has first
supplied the board with a self-addressed, stamped envelope for the transmission
of each requested notice. (b) Any person who desires individual electronic mail notice of
the meetings described in paragraph (S)(1) of this rule shall make a request in
writing to the board at its business address. The board shall maintain a list
of all persons who have requested individual electronic mail notice in this
manner. The board may purge the list of all entries as it deems appropriate
provided, however, that the board shall first provide notice to any individual
whose contact information will be purged at least thirty days in
advance. (c) Any person who desires individual facsimile mail notice of
the meetings described in paragraph (S)(1) of this rule shall make a request in
writing to the board at its business address. The board shall maintain a list
of all persons who have requested individual facsimile notice in this manner.
The board may purge the list of all entries as it deems appropriate provided,
however, that the board shall first provide notice to any individual whose
contact information will be purged at least thirty days in
advance. (d) The board may, at its sole option, provide for an electronic
means of requesting individual electronic mail of facsimile notice of the
meetings described in paragraph (S)(1) of this rule. (3) A representative of
the news media may obtain notice of all special or emergency meetings of the
council, its committees or its subcommittees by requesting such in writing to
the "Ohio Mine Subsidence Insurance Governing Board" at its business
address. (a) The request must provide the name of the person to be
contacted, the agency whom the person represents, and shall state whether the
person wishes to be notified of regular, special, or emergency meetings, or any
combination thereof. Additionally, the request shall specify whether the person
wishes to be notified by mail, electronic mail, or facsimile, and shall include
the appropriate contact information. (b) The board shall maintain a list of all news media
representatives requesting notice of special meetings. The board may purge the
list of all entries as it deems appropriate provided, however, that the board
shall first provide notice to an individual whose contact information will be
purged at least thirty days in advance. (c) Notice of special meetings shall be provided to news media
representatives at least twenty-four hours prior to the special meeting. Notice
of emergency meetings shall be provided to news media representatives by
telephone or electronic means as soon as practicable. (4) Notice given by mail
is effective upon mailing. Notice given by telephone is effective upon
providing actual notice, leaving a message containing the meeting information
with any individual who answers the number provided by the requestor or leaving
a recorded message, or, if the board makes three unsuccessful attempts to
contact the requestor directly or to leave a voice message. Notice given by
electronic means shall be complete upon transmission. (T) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated February 14, 2022 at 8:55 AM
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Rule 3901-1-50 | Annual financial reports.
(A) Purpose (1) The purpose of this rule is to facilitate the department's surveillance of the financial condition of insurers by requiring (a) an annual audit of financial statements reporting the financial position and results of operation of insurers by independent certified public accountants, (b) communication of internal control related matters noted in an audit, and (c) management's report of internal control over financial reporting. This rule shall apply to all insurers, except those insurers having direct premiums written of less than one million dollars and having less than one thousand policyholders nationwide at the end of any year. Those insurers will be exempt from this rule for the year they do not meet this threshold unless the superintendent makes a specific finding that compliance by the insurer is necessary for the superintendent to carry out his or her statutory responsibilities. Insurers having assumed premiums to contracts and/or treaties of reinsurance of one million dollars or more will not be exempt. Insurers filing audited financial reports in another state, pursuant to such other state's requirement of audited financial reports, which are found by the superintendent to be substantially similar to the requirements herein, are exempt from this rule if: (a) A copy of the audited financial report, communication of internal control related matters noted in audit, and the accountant's letter of qualifications, which are filed with such other states are filed with the superintendent in accordance with the filing dates specified in paragraphs (D), (K) and (L) of this rule. (Canadian insurers may submit accountants' reports as filed with the office of the superintendent of financial institutions, Canada); and (b) A copy of any notification or report of adverse financial condition filed with such other state is filed with the superintendent within the time specified in paragraph (J) of this rule. Foreign or alien insurers required to file management's report of internal control over financial reporting in another state are exempt from filing the report in this state provided the other state has substantially similar reporting requirements and the report is filed with the superintendent of the other state within the time specified. (2) This rule shall not prohibit, preclude or in any way limit the superintendent from ordering, conducting and performing examinations of insurers under the rules and regulations and the practice and procedures of the department. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code which requires the superintendent to adopt, amend, and rescind rules and make adjudications necessary to discharge his or her duties and exercise his or her powers under Title XXXIX of the Revised Code, subject to sections 119.01 to 119.13 of the Revised Code. This rule is issued to implement sections 3901.04, 3901.07 and 3901.77 of the Revised Code. (C) Definitions (1) "Audited Financial Report" means the annual report defined in the items specified in paragraph (E) of this rule. (2) "Accountant" and "Independent Certified Public Accountant" mean an independent certified public accountant or accounting firm, as defined by the general standards of the "American Institute of Certified Public Accountants," in good standing with the "American Institute of Certified Public Accountants" and in all states in which it is licensed to practice; for Canadian and British companies, it means a Canadian-chartered or British-chartered accountant. (3) An "affiliate" of, or person "affiliated" with, a specific person, is a person that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified. (4) "Audit committee" means a committee (or equivalent body) established by the board of directors of an entity for the purpose of overseeing the accounting and financial reporting process of an insurer or group of insurers, the internal audit function of an insurer or group of insurers (if applicable), and external audits of financial statements of the insurer or group of insurers. The audit committee of any entity that controls a group of insurers may be deemed to be the audit committee for one or more of these controlled insurers solely for the purposes of this rule at the election of the controlling person. Refer to paragraph (N) of this rule for exercising this election. If an audit committee is not designated by the insurer, the insurer's entire board of directors shall constitute the audit committee. (5) "Department" means the Ohio department of insurance. (6) "Indemnification" means an agreement of indemnity or a release from liability where the intent or effect is to shift or limit in any manner the potential liability of the person or firm for failure to adhere to applicable auditing or professional standards, whether or not resulting in part from knowing of other misrepresentations made by the insurer or its representatives. (7) "Independent board member" has the same meaning as described in paragraph (N) of this rule. (8) "Internal audit function" means a person or persons that provide independent, objective and reasonable assurance designed to add value and improve an organization's operations and accomplish its objectives by bringing a systematic disciplined approach to evaluate and improve the effectiveness of risk management, control and governance processes. (9) "Internal control over financial reporting" means a process effected by an entity's board of directors, management and other personnel designed to provide reasonable assurance regarding the reliability of the financial statements, i.e., those items specified in paragraphs (E)(2) to (E)(7) of this rule, and includes those policies and procedures that: (a) Pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of assets; (b) Provide reasonable assurance that transactions are recorded as necessary to permit preparation of the financial statements, i.e., these items specified in paragraphs (E)(2) to (E)(7) of this rule, and that receipts and expenditures are being made only in accordance with authorizations of management and directors; and (c) Provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or disposition of assets that could have a material effect on the financial statements, i.e., these items specified in paragraphs (E)(2) to (E)(7) of this rule. (10) "SEC" means the United States securities and exchange commission. (11) "Section 404" means section 404 of the Sarbanes-Oxley Act of 2002 and the SEC's rules and regulations promulgated thereunder. (12) "Section 404 Report" means management's report on "internal control over financial reporting" as defined by the SEC and the related attestation report of the independent certified public accountant as described in paragraph (C)(2) of this rule. (13) "SOX Compliant Entity" means an entity that either is required to be compliant with, all of the following provisions of the Sarbanes-Oxley Act of 2002: (i) the preapproval requirements of section 201 (section 10A(i) of the Securities Exchange Act of 1934); (ii) the audit committee independence requirements of section 301 (section 10A(m)(3) of the Securities Exchange Act of 1934); and (iii) the internal control over financial reporting requirements of section 404 (item 308 of SEC regulation S-K0). (14) "Insurer" means an entity licensed pursuant to Chapter 1739., 1751., 3907., 3909., 3911., 3925., 3929., 3931. or 3953. of the Revised Code. (15) "Group of Insurers" means those entities included in the reporting requirements of sections 3901.32 to 3901.37 of the Revised Code, or a set of insurers as identified by management, for the purpose of assessing the effectiveness of internal controls over financial reporting. (16) "Statutory accounting practices" has the meaning defined in the current editions of "Annual Statement Instructions" and the "Accounting Practices and Procedures Manual" published by the "National Association of Insurance Commissioners," or as otherwise prescribed by the insurance department of the insurer's state of domicile. (17) "Superintendent" means the superintendent of the Ohio department of insurance. (18) "Workpapers" means the records kept by an independent certified public accountant of the procedures followed, the tests performed, the information obtained, and the conclusions reached pertinent to his or her audit of the financial statements of an insurer. Workpapers may include audit planning documentation, work programs, analyses, memoranda, letters of confirmation and representation, abstracts of company documents and schedules of commentaries prepared or obtained by the independent certified public accountant in the course of his or her audit of the financial statements of an insurer and, which support his or her opinion thereof. (D) General requirements related to filing and extensions for filing of audited financial reports and audit committee appointment All insurers shall have an annual audit by an independent certified public accountant and shall file an audited financial report as a supplement to the annual statement with the superintendent on or before June first for the immediately preceding year ended December thirty-first. Extensions of the June first filing date may be granted in writing by the superintendent for thirty day periods upon showing by the insurer and its independent certified public accountant the reasons for requesting such extension and determination by the superintendent of good cause for an extension. The request for an extension must be submitted in writing not less than ten days prior to the due date in sufficient detail to permit the superintendent to make an informed decision with respect to the requested extension. If an extension is granted, a similar extension of thirty days is granted to the filing of management's report of internal control over financial reporting. Every insurer required to file an annual audited financial report pursuant to this rule shall designate a group of individuals as constituting its audit committee, as defined in paragraph (C)(4) of this rule. The audit committee of any entity that controls an insurer may be deemed to be the insurer's audit committee for purposes of this rule at the election of the controlling person. The superintendent may require an insurer to file an audited financial report earlier than June first with ninety days advance notice to the insurer. (E) Contents of audited financial report The audited financial report shall report the financial condition of the insurer as of the end of the most recent calendar year and the results of its operations, cash flows, and changes in capital and surplus for the year then ended in conformity with statutory accounting practices. The audited financial report shall include the following items: (1) Report of independent certified public accountant; (2) Balance sheet reporting admitted assets, liabilities, capital and surplus; (3) Statement of operations; (4) Statement of cash flows; (5) Statement of changes in capital and surplus; (6) Notes to financial statements. These notes shall be those appropriate to a CPA audited financial report, based on applicability, materiality and significance, taking into account the subjects covered in the instructions to and illustrations of how to report information in the notes to financial statements section of the "NAIC" annual statement instructions and any other notes required by the "NAIC Accounting Practices and Procedures Manual" and shall include: (a) A reconciliation of differences, if any, between the audited statutory financial statements and the annual financial statement filed with the superintendent including a written description of the nature of these differences; and (b) A narrative explanation of all significant intercompany transactions and balances; and (c) A summary of ownership and relationships of the insurer and all affiliated companies. (7) The financial statements included in the audited financial report shall be prepared in a form and using language and groupings substantially the same as the relevant sections of the annual financial statement of the insurer filed with the superintendent and: (a) The financial statements shall be comparative, presenting the amounts as of December thirty-first of the current year and amounts as of the immediately preceding year ending December thirty-first. (However, in the first year in which an insurer is required to file an audited financial report, the comparative data may be omitted); and (b) Amounts may be rounded to the nearest thousand dollars. (F) Designation of independent certified public accountant (1) Each insurer required by this rule to file an audited financial report must, within sixty days after becoming subject to such requirement, register with the superintendent, in writing, the name and address of the independent certified public accountant retained to conduct the annual audit required in this rule. Insurers not previously retaining an independent certified public accountant shall register the name and address of their retained independent certified public accountant not less than six months before the date when the first audited financial report is to be filed. (2) The insurer shall obtain a letter from such accountant, and file a copy of such letter with the superintendent, stating that the accountant is aware of the provisions of the insurance code and the rules and regulations of the insurance department of its state of domicile that relate to accounting and financial matters and affirming that he or she will express his or her opinion on the financial statements of the insurer in the terms of their conformity to the statutory accounting practices prescribed or otherwise permitted by such insurance department, specifying such exceptions as he or she may believe appropriate. If an accountant, who was not the accountant for the insurer's most recently filed audited financial report, is engaged to audit the insurer's financial statements, the insurer shall, within thirty days of the date the accountant is engaged, notify the department of this event. (3) If an accountant who was the accountant for the immediately preceding filed audited financial report is dismissed or resigns, the insurer shall within five business days notify the department of insurance of this event. The insurer shall also furnish the superintendent with a separate letter within ten business days of the above notification stating whether in the twenty four months preceding such engagement there were any disagreements with the former accountant on any matter of accounting principles or practices, financial statement disclosure, or auditing scope or procedure, which disagreements, if not resolved to the satisfaction of the former accountant, would have caused him or her to make reference to the subject matter of the disagreement in connection with his or her opinion. Disagreements contemplated by this paragraph are those that occur at the decision-making level, i.e., between personnel of the insurer responsible for presentation of its financial statements and personnel of the accounting firm responsible for rendering its report. The insurer shall also request, in writing, such former accountant to furnish a letter, addressed to the insurer, stating whether the accountant agrees with the statements contained in the insurer's letter and, if not, stating the reasons for which he or she does not agree; and the insurer shall furnish such responsive letter from the former accountant to the superintendent, together with its own letter. (G) Qualifications of independent certified public accountant An insurer may not use any person or firm as an independent certified public accountant if such person or firm: (1) is not in good standing with the "American Institute of Certified Public Accountants" in all states in which the person or firm is licensed to practice or, for a Canadian or British company, that is not a chartered accountant; (2) has either directly or indirectly entered into an agreement of indemnity or release from liability (collectively referred to as "indemnification") with respect to the audit of the insurer. Except as otherwise provided herein, an insurer may use a certified public accountant as its independent certified public accountant only if and for as long as such accountant conforms to the standards of his or her profession, as contained in the "Code of Professional Conduct" of the "American Institute of Certified Public Accountants" and "Rules of Professional Conduct" of the "Accountancy Board of Ohio," or similar code. The lead (or coordinating) audit partner (having primary responsibility for the audit) may not act in that capacity for more than five consecutive years. The person shall be disqualified from acting in that or a similar capacity for the same company or its insurance subsidiaries or affiliates for a period of five consecutive years. An insurer may make application to the superintendent of insurance for relief from the above rotation requirement on the basis of unusual circumstances. This application should be made at least thirty days before the end of the calendar year. The superintendent may consider the following factors in determining if the relief should be granted: (a) number of partners, expertise of the partners or the number of insurance clients in the currently registered firm; (b) premium volume of the insurer; or (c) number of jurisdictions in which the insurer transacts business. The insurers shall file, with its annual statement filing, the proof of relief from the five years limitation with the states that it is licensed in or doing business in and with the "National Association of Insurance Commissioners." If the nondomestic state accepts electronic files with the NAIC, the insurer shall file the approval in an electronic format acceptable to the "National Association of Insurance Commissioners." The superintendent shall not recognize as a qualified independent certified public accountant, nor accept any annual audited financial report, prepared in whole or in part by, any natural person who (1) has been convicted of fraud, bribery, a violation of the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. sections 1961-1968, or any dishonest conduct or practices under federal or state law; (2) has been found to have violated the insurance laws of this state with respect to any previous reports submitted under this rule; or (3) has demonstrated a pattern or practice of failing to detect or disclose material information in previous reports filed under the provisions of this requirement. The superintendent may hold a hearing to determine whether a certified public accountant is qualified and, considering the evidence presented, may rule that the accountant is not qualified for purposes of expressing his or her opinion on the financial statements in the annual audited financial report made pursuant to this requirement and require the insurer to replace the accountant with another whose relationship with the insurer is qualified within the meaning of this requirement. (1) The superintendent shall not recognize as a qualified independent certified public accountant, nor accept an annual audited financial report, prepared in whole or in part by an accountant who provides to an insurer, contemporaneously with the audit, the following non-audit services: (a) Bookkeeping or other services related to the accounting records or financial statements of the insurer; (b) Financial information systems design and implementation; (c) Appraisal or valuation services, fairness opinions, or contribution-in-kind reports; (d) Actuarial-oriented advisory services involving the determination of amounts recorded in the financial statements. The accountant may assist an insurer in understanding the methods, assumptions and inputs used in the determination of amounts recorded in the financial statement only if it is reasonable to conclude that the services provided will not be subject to audit procedures during an audit of the insurer's financial statements. An accountant's actuary may also issue an actuarial opinion or certification ("opinion") on an insurer's reserves if the following conditions have been met: (i) Neither the accountant nor the accountant's actuary has performed any management functions or made any management decisions: (ii) The insurer has competent personnel (or engages a third party actuary) to estimate the reserves for which management takes responsibility: (iii) The accountant's actuary tests the reasonableness of the reserves after the insurer's management has determined the amount of the reserves: (e) Internal audit outsourcing services: (f) Management functions or human resources: (g) Broker or dealer, investment advisor, or investment banking services: (h) Legal services or expert services unrelated to the audit: or (i) Any other services that the superintendent determines, by rule, are impermissible. (2) In general, the principles of independence with respect to services provided by the qualified independent certified public accountant are largely predicted on three basic principles, violations of which would impair the accountant's independence. The principles are that the accountant cannot function in the role of management, cannot audit his or her own work, and cannot serve in an advocacy role for the insurer. Insurers having direct written and assumed premiums of less than one hundred million dollars in any calendar year may request an exemption from this paragraph. The insurer shall file with the superintendent a written statement discussing the reasons why the insurer should be exempt from these provisions. If the superintendent finds, upon review of this statement, that compliance with this rule would constitute a financial or organizational hardship upon the insurer, an exemption may be granted. (3) A qualified independent certified public accountant who performs the audit may engage in other non-audit services for an insurer, including tax services, that are not described in paragraph (G)(1) of this rule or that do not conflict with paragraph (G)(2) of this rule, only if the activity is approved in advance by the audit committee for the insurer, in accordance with paragraph (G)(4) of this rule. (4) All auditing services and non-audit services provided to an insurer by the qualified independent certified public accountant of the insurer shall be preapproved by the audit committee of the insurer. The preapproval requirement is waived with respect to non-audit services if the insurer is a "SOX" compliant entity or a direct or indirect wholly-owned subsidiary of a "SOX" compliant entity or; (a) The aggregate amount of all such non-audit services provided to the insurer constitutes not more than five per cent of the total amount of fees paid by the insurer to its qualified independent certified public account during the fiscal year in which the non-audit services are provided: (b) The services were not recognized by the insurer at the time of the engagement to be non-audit services; and (c) The services are promptly brought to the attention of the audit committee and approved prior to the completion of the audit by the audit committee or by one or more members of the audit committee who are members of the board of directors to whom authority to grant such approvals has been delegated by the audit committee. (5) The audit committee of an insurer may delegate to one or more designated members of the audit committee the authority to grant the preapprovals required by paragraph (G)(4) of this rule. The decisions of any member to whom this authority is delegated shall be presented to the full audit committee at each of its scheduled meetings. (6) The superintendent shall not recognize an independent certified public accountant as qualified for particular insurer if a member of the board, president, chief executive officer, controller, chief financial officer, chief accounting officer, or any person serving in an equivalent position for that insurer, was employed by the independent certified public accountant and participated in the audit of that insurer during the one year period preceding the date that the most current statutory opinion is due. This section shall only apply to partners and senior managers involved in the insurer's preceding audit. An insurer may make an application to the superintendent for relief from the requirement on the basis of unusual circumstances. (7) The insurer shall file, with its annual statement filing, the approval for relief from paragraph (G)(6) of this rule with the states that it is licensed in or doing business in and the NAIC. If the nondomestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic format acceptable to the NAIC. (H) Consolidated or combined audits An insurer may make an annual written application to the superintendent for approval to file audited consolidated or combined financial statements in lieu of separate annual audited financial statements if the insurer is part of a group of insurance companies which utilizes a pooling or one hundred percent reinsurance agreement that affects the solvency and integrity of the insurer's reserves and such insurer cedes all of its direct and assumed business to the pool. In such cases, a columnar consolidating or combining worksheet shall be filed with the report, as follows: (1) Amounts shown on the consolidated or combined audited financial report shall be shown on the worksheet; (2) Amounts for each insurer subject to this rule shall be stated separately; (3) Non-insurance operations may be shown on the worksheet on a combined or individual basis; (4) Explanations of consolidating and eliminating entries shall be included; and (5) A reconciliation shall be included of any differences between the amounts shown in the individual insurer columns of the worksheet and comparable amounts shown on the financial statements of the insurers. (I) Scope of audit and report of independent certified public accountant Financial statements furnished pursuant to paragraph (E) of this rule shall be examined by an independent certified public accountant. The audit of the insurer's financial statements shall be conducted in accordance with generally accepted auditing standards. In accordance with AU section 319 of the professional standards of the accountants "American Institute of Certified Public Accountants," consideration of internal control in a financial statement audit, the independent certified public accountant should obtain an understanding of internal control sufficient to plan the audit. To the extent required by AU section 319, for those insurers required to file a management's report of internal control over financial reporting pursuant to paragraph (Q) of this rule, the independent certified public accountant should consider (as that term is defined in Statement on Auditing Standards (SAS) No. 102, defining professional requirements in statements on auditing standards or its replacement) the most recently available report in planning and performing the audit of the statutory financial statements. Consideration should be given to such other standards illustrated in the "Financial Condition Examiner's Handbook" promulgated by the "National Association of Insurance Commissioners" as the independent certified public accountant deems necessary. (J) Notification of adverse financial condition (1) The insurer required to furnish the annual audited financial report shall require the independent certified public accountant to report in writing within five business days to the board of directors or its audit committee any determination by the independent certified public accountant that the insurer has materially misstated its financial condition as reported to the superintendent as of the balance sheet date currently under audit or that the insurer does not meet the minimum capital and surplus requirement of the Revised Code as of that date. An insurer who has received a report pursuant to this paragraph shall forward a copy of the report to the superintendent within five business days of receipt of such report and shall provide the independent certified public accountant making the report with evidence of the report being furnished to the superintendent. If the independent certified public accountant fails to receive such evidence within the required five business day period, the independent certified public accountant shall furnish to the superintendent a copy of its report within the next five business days. (2) No independent certified public accountant shall be liable in any manner to any person for any statement made in connection with the above paragraph if such statement is made in good faith in compliance with the above paragraph. (3) If the accountant, subsequent to the date of the audited financial report filed pursuant to this rule, becomes aware of facts which might have affected his or her report, the department shall note the obligation of the accountant to take such action as prescribed in volume one, section AU five hundred sixty one of the "Professional Standards of the American Institute of Certified Public Accountants," as amended. (K) Communication of internal control related matters noted in an audit In addition to the annual audited financial report, each insurer shall furnish the superintendent with a written communication as to any unremediated material weakness in its internal controls over financial reporting noted during the audit. Such communication shall be prepared by the accountant within sixty days after the filing of the annual audited financial report, and shall contain: (1) A description of any unremediated material weakness (as the term material weakness is defined by statement on auditing standard sixty, communication of internal control related matters noted in an audit, or its replacement) as of December thirty-first immediately preceding (so as to coincide with the audited financial report discussed in paragraph (D) of this rule) in the insurer's internal control over financial reporting noted by the accountant during the course of their audit of the financial statements. If no unremediated material weaknesses are noted, the communication should so state. (2) The insurer is required to provide a description of remedial action taken or proposed to correct unremediated material weaknesses, if the actions are not described in the accountant's communications. (L) Accountant's letter of qualifications The accountant shall furnish the insurer in connection with, and for inclusion in, the filing of the annual audited financial report, a letter stating: (1) That he or she is independent with respect to the insurer and conforms to the standards of his or her profession as contained in the "Code of Professional Ethics" and pronouncements of the "American Institute of Certified Public Accountants" and the "Rules of Professional Conduct" of the "Accountancy Board of Ohio" or other state board of public accountancy that performs the same licensing function. (2) The background and experience in general, and the experience in audits of insurers of the staff assigned to the engagement and whether each is an independent certified public accountant. Nothing within this requirement shall be construed as prohibiting the accountant from utilizing such staff as he or she deems appropriate where such use is consistent with the standards prescribed by generally accepted auditing standards. (3) That the accountant understands the annual audited financial report and his or her opinion thereon will be filed in compliance with this requirement and that the superintendent will be relying on this information in the monitoring and regulation of the financial position of insurers. (4) That the accountant consents to the requirements of paragraph (M) of this rule and that the accountant consents and agrees to make available for review by the superintendent his or her designee or his or her appointed agent, the workpapers, as defined in paragraph (C)(18) of this rule. (5) A representation that the accountant is properly licensed by an appropriate state licensing authority and is a member in good standing in the "American Institute of Certified Public Accountants." (6) A representation that the accountant is in compliance with the requirements of paragraph (G) of this rule. (M) Availability and maintenance of independent certified public accountant workpapers Every insurer required to file an audited financial report pursuant to this rule shall require the accountant to make available for review by department examiners the workpapers prepared in the conduct of his or her audit and any communications related to the audit between the accountant and the insurer, at the offices of the insurer, at the department, or at any other reasonable place designated by the superintendent. The insurer shall require that the accountant retain the workpapers and communications until the domiciliary department has filed a report on examination covering the period of the audit, but for no longer than seven years from the date of the audit report. In the conduct of the aforementioned periodic review by the domiciliary department examiners, it shall be agreed that photocopies of pertinent audit workpapers may be made and retained by the domiciliary department. Such reviews by the domiciliary department examiners shall be considered investigations and all workpapers and communications obtained during the course of such investigations shall be afforded the same confidentiality as other examination workpapers generated by the domiciliary department. (N) Requirements for audit committees This section shall not apply to foreign or alien insurers licensed in this state or an insurer that is a "SOX" compliant entity or a direct or indirect wholly-owned subsidiary of a "SOX" compliant entity. The audit committee shall be directly responsible for the appointment, compensation and oversight of the work of any accountant (including resolution of disagreements between management and the accountant regarding financial reporting) for the purpose of preparing or issuing audited financial report or related work pursuant to this regulation. Each accountant shall report directly to the audit committee. The audit committee of an insurer or group of insurers shall be responsible for overseeing the insurer's internal audit function and granting the person or persons performing the function suitable authority and resources to fulfill their responsibilities if required by paragraph (O) of this rule. Each member of the audit committee shall be a member of the board of directors of the insurer or a member of the board of directors of an entity elected pursuant to this paragraph and paragraph (C)(4) of this rule. In order to be considered independent for purposes of this rule, a member of the audit committee may not, other than in his or her capacity as a member of the audit committee, the board of directors, or any other board committee, accept any consulting, advisory or other compensatory fee from the entity or be an affiliated person of the entity or any subsidiary thereof. However, if law requires the board participation by otherwise non-independent members, that law shall prevail and such members may participate in the audit committee and be designated as independent for audit committee purposes, unless they are an officer or employee of the insurer or one of its affiliates. If a member of the audit committee ceases to be independent for reasons outside the member's reasonable control, that person, with notice by the responsible entity to the domiciliary state, may remain an audit committee member of the responsible entity until the earlier of the next annual meeting of the responsible entity or one year from the occurrence of the event that caused the member to be no longer independent. To exercise the election of the controlling person to designate the audit committee for purposes of this rule, the ultimate controlling person shall provide written notice to the domiciliary commissioners of the affected insurers. Notification shall be made timely prior to the issuance of the statutory audit report and include a description of the basis for the election. The election can be changed through notice to the domiciliary commissioner by the insurer, which shall include a description of the basis for the change. The election shall remain in effect for perpetuity, until rescinded. The audit committee shall require the accountant that performs for an insurer any audit required by this regulation to timely report to the audit committee in accordance with the requirements of "SAS" No. 61, "Communication with Audit Committees," or its replacement, including: All significant accounting policies and material permitted practices; All material alternative treatments of financial information within statutory accounting principles that have been discussed with management officials of the insurer, ramifications of the use of the alternative disclosures and treatments, and the treatment preferred by the accountant; and other material written communications between the accountant and the management of the insurer, such as any management letter or schedule of unadjusted differences. If an insurer is a member of an insurance holding company system, the reports required above may be provided to the audit committee on an aggregate basis for insurers in the holding company system, provided that any substantial differences among insurers in the system are identified to the audit committee. The portion of independent audit committee members shall meet or exceed the following criteria: $0- $300,000,000 | $300,000,000- $500,000,000 | Over $500,000,000 | No minimum requirements. See also note A and B. | Majority (50% or more) of members shall be independent. See also note A and B. | Supermajority of members (75% or more) shall be independent. See also Note A and B. |
Note A: The superintendent has authority afforded by state law to require the entity's board to enact improvements to the independence of the audit committee membership if the insurer is in a "RBC" action level event, meets one or more of the standards of an insurer deemed to be in hazardous financial condition, or otherwise exhibits qualities of a troubled insurer. Note B: All insurers with less than five hundred million dollars in prior year direct written and assumed premiums are encouraged to structure their audit committees with at least a supermajority of independent audit committee members. Note C: Prior calendar year direct written and assumed premiums shall be the combined total of direct premiums and assumed premiums from non-affiliates for the reporting entities. An insurer with direct written and assumed premium, excluding premiums reinsured with the federal crop insurance corporation and federal flood program, less than five hundred million dollars may make application to the superintendent for a waiver from these requirements based upon hardship. The insurer shall file, with its annual statement filing, the approval for relief from paragraph (N) of this rule with the states that it is licensed in or doing business in and the NAIC. If the non-domestic state accepts electronic filing with the NAIC, the insurer shall file the approval in an electronic format acceptable to the NAIC. (O) Internal audit function requirements (1) An insurer is exempt from the requirements of paragraph (O) of this rule if: (a) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the "Federal Crop Insurance Corporation" and "Federal Flood Program," less than five hundred million dollars; and (b) If the insurer is a member of a group of insurers that has an annual direct written and unaffiliated assumed premium including international direct and assumed premium, but excluding premiums reinsured with the "Federal Crop Insurance Corporation" and "Federal Flood Program," less than one billion dollars. (2) The insurer or group of insurers shall establish an internal audit function providing independent, objective and reasonable assurance to the audit committee and insurer management regarding the insurer's governance, risk management and internal controls. This assurance shall be provided by performing general and specific audits, reviews and tests and by employing other techniques deemed necessary to protect assets, evaluate control effectiveness and efficiency, and evaluate compliance with policies and regulations. (3) In order to ensure that internal auditors remain objective, the internal audit function must be organizationally independent. Specifically, the internal audit function will not defer ultimate judgment on audit matters to others, and shall appoint an individual to head the internal audit function who will have direct and unrestricted access to the board of directors. Organizational independence does not preclude dual-reporting relationships. (4) The head of internal audit function shall report to the audit committee regularly, but no less than annually, on the periodic audit plan, factors that may adversely impact the internal audit function's independence or effectiveness, material findings from completed audits and the appropriateness of corrective actions implemented by management as a result of audit findings. (5) If an insurer is a member of an insurance holding company system or included in a group of insurers, the insurer may satisfy the internal audit function requirements set forth in paragraph (O) of this rule at the ultimate controlling parent level, an intermediate holding company level or the individual legal entity level. (P) Conduct of insurer in connection with the preparation of required reports and documents No director or officer of an insurer shall, directly or indirectly: (1) Make or cause to be made a materially false or misleading statement to an accountant in connection with any audit, review or communication required under this rule; or (2) Omit to state, or cause another person to omit to state, any material fact necessary in order to make statements made, in light of the circumstances under which the statements were made, not misleading to an accountant in connection with any audit, review or communication required under this rule. No officer or director of an insurer, or any other person acting under the direction thereof, shall directly or indirectly take any action to coerce, manipulate, mislead or fraudulently influence any accountant engaged in the performance of an audit pursuant to this rule if that person knew or should have known that the action, if successful, could result in rendering the insurer's financial statements materially misleading. Actions that, "if successful, could result in rendering the insurer's financial statements materially misleading" include, but are not limited to, actions taken at any time with respect to the professional engagement period to coerce, manipulate, mislead or fraudulently influence an accountant: (a) To issue or reissue a report on an insurer's financial statements that is not warranted in the circumstances (due to material violations of statutory accounting principles prescribed by the commissioner, generally accepted auditing standards, or other professional or regulatory standards): (b) Not to perform audit, review or other procedures required by generally accepted auditing standards or other professional standards; (c) Not to withdraw an issued report; or (d) Not to communicate matters to an insurer's audit committee. (Q) Management's report of internal control over financial reporting Every insurer required to file an audited financial report pursuant to this rule that has annual direct written and assumed premiums, excluding premiums reinsured with the federal crop insurance corporation and federal flood program, of five hundred million dollars or more shall prepare a report of the insurer's or group of insurer's internal control over financial reporting as these terms are defined in paragraph (C) of this rule. The report shall be filed with the superintendent along with the communication of internal control related matters noted in an audit described in paragraph (K) of this rule. Management's report of internal control over financial reporting shall be as of December thirty-first immediately preceding. Notwithstanding the premium threshold, as stated above, the superintendent may require an insurer to file management's report of internal control over financial reporting if the insurer is in any "RBC" level event, or meets any one or more of the standards of an insurer deemed to be in hazardous financial condition as defined in sections 3903.09 and 3903.71 of the Revised Code and rule 3901-3-04 of the Administrative Code. An insurer or a group of insurers that is: (1) Directly subject to "Section 404"; (2) Part of a holding company system whose parent is directly subject to "Section 404"; (3) Not directly subject to "Section 404" but is a "SOX" compliant entity; or (4) A member of a holding company system whose parent is not directly subject to "Section 404" but is a "SOX" compliant entity, may file its or its parents "Section 404" report on internal control and an addendum in satisfaction of this paragraph's requirement provided that those internal controls of the insurer or group of insurers having a material impact on the preparation of the insurer or group of insurers' its audited statutory financial statements were included in the scope of the "Section 404" reports. The addendum shall be a positive statement by management that there are no material processes with respect to the preparation of the insurer's or group of insurers' audited statutory financial statements excluded from the "Section 404" report. If there are internal controls of the insurer or group of insurers that have a material impact on the preparation of the insurer's or group of insurers' audited statutory financial statements and those internal controls were not included in the scope of the "Section 404" report, the insurer or group of insurers may either file (a) a report as required by paragraph (Q) of this rule, or (b) the "Section 404" report and a report as required by paragraph (Q) of this rule for those internal controls that have a material impact on the insurer's or group of insurers' audited statutory financial statements not covered by the "Section 404" report. Management's report of internal control over financial reporting shall include: (a) A statement that management is responsible for establishing and maintaining adequate control over financial reporting; (b) A statement that management has established internal control over financial reporting and an assertion to the best of management's knowledge and belief, after diligent inquiry, as to whether its internal control over financial reporting is effective to provide reasonable assurance regarding the reliability of financial statements in accordance with statutory accounting principles; (c) A statement that briefly describes the approach or process by which management evaluated the effectiveness of its internal control over financial reporting; (d) A statement that briefly describes the scope of work that is included and whether any internal controls were excluded; (e) Disclosure of any unremediated material weaknesses in internal control over financial reporting identified by management as of December thirty-first immediately preceding. Management is not permitted to conclude that the internal control over financial reporting is effective to provide reasonable assurance regarding the reliability of financial statements in accordance with statutory accounting principles if there is one or more unremediated material weakness in its internal controls over financial reporting; (f) A statement regarding the inherent limitations of internal control systems; and (g) Signatures of the chief executive officer and the chief financial officer (or equivalent position/title). Management shall document and make available upon financial condition examination the basis upon which its assertions, required in above, are made. Management may base its assertions, in part, upon its review, monitoring and testing of internal controls undertaken in the normal course of its activities. (i) Management shall have discretion as to the nature of the internal control framework used, and the nature and extent of documentation, in order to make its assertion in a cost effective manner, as such, may include assembly of or reference to existing documentation. (ii) Management's report on internal control over financial reporting, required above, and any documentation provided in support thereof during the course of a financial condition examination, shall be kept confidential by the superintendent. (R) Exemptions and effective dates (1) Upon written application of any insurer, the superintendent may grant an exemption from compliance with any and all provisions this rule if the superintendent finds, upon review of the application, that compliance with this rule would constitute a financial or organizational hardship upon the insurer. An exemption may be granted at any time and from time to time for any specified period. Domestic insurers retaining an independent certified public accountant on the effective date of this rule shall comply with this rule for the year ending December 31, 2008, and each year thereafter unless the superintendent permits otherwise. Domestic insurers not retaining an independent certified public accountant on the effective date of this rule shall meet the following schedule for compliance, unless the superintendent gives his or her written permission otherwise. (a) For the year ending December 31, 2008, file with the superintendent an audited financial report: (b) For the year ending December 31, 2009, and each year thereafter, such insurers shall file with the superintendent all reports and communications required by this rule. (2) Foreign insurers shall comply with this rule for the year ending December 31, 2009, and each year thereafter, unless the superintendent gives his or her written permission otherwise. (3) The requirements of paragraph (G) of this rule shall be in effect for audits of the year beginning January 1, 2010 and thereafter. (4) The requirements of paragraph (N) of this rule are to be in effect January 1, 2010. An insurer or group of insurers that is not required to have independent audit committee members or only a majority of independent audit committee members (as opposed to a supermajority) because the total written and assumed premium is below the threshold and subsequently becomes subject to one of the independence requirements due to changes in premium shall have one year following the year threshold is exceeded (but not earlier than January 1, 2010) to comply with the independence requirements. Likewise, an insurer that becomes subject to one of the independence requirements as a result of a business combination shall have one calendar year following the date of acquisition or combination to comply with the independence requirements. (5) The requirements of paragraph (O) of this rule are to be in effect January 1, 2016. If an insurer or group of insurers that is exempt from paragraph (O) of this rule requirements no longer qualifies for the exemption, it shall have one year after the threshold is exceeded to comply with the requirements of paragraph (O) of this rule. (6) The requirements of paragraph (Q) of this rule, except for paragraph (N) of this rule covered above, are effective beginning with the reporting period December 31, 2010 and each year thereafter. An insurer or group of insurers that is not required to file a report because the total written premium is below the threshold and subsequently becomes subject to the reporting requirements shall have two years following the year the threshold is exceeded (but not earlier than December 31, 2010) to file a report. Likewise, an insurer acquired in a business combination shall have two calendar years following the date of acquisition or combination to comply with the reporting requirements. (S) Canadian and British companies In the case of Canadian and British insurers, the audited financial report shall be defined as the annual statement of total business on the form filed by such companies with their domiciliary supervision authority duly audited by an independent chartered accountant. For such insurers, the letter required in paragraph (F)(2) of this rule shall state that the accountant is aware of the requirements relating to the audited financial report filed with the superintendent pursuant to paragraph (Q) of this rule and shall affirm that the opinion expressed is in conformity with such requirements. (T) Severability If any paragraph, term or provision of this rule is adjudged invalid for any reason, the judgment shall not affect, impair or invalidate any other paragraph, term or provision of this rule, but the remaining paragraphs, terms and provisions shall be and continue in full force and effect.
Last updated May 10, 2021 at 10:10 AM
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Rule 3901-1-52 | Life and health insurance guaranty association disclaimer and not covered form.
Effective:
November 16, 2023
(A) Purpose The purpose of this rule is to establish the form
and content of the summary document and disclaimer describing the general
purposes and current limitations of the Ohio life and health insurance guaranty
association and the notice that the policy or contract, or portion thereof, may
not be covered by the association. (B) Authority This rule is issued pursuant to the authority
vested in the superintendent under section 3956.18 of the Revised Code. (C) Applicability This rule applies to all insurers, health
insuring corporations, and agents providing, soliciting or negotiating coverage
for direct, non-group life insurance, health insurance, including sickness and
accident insurance policies and contracts, and health insuring corporation
subscriber policies, contracts, certificates and agreements, annuities,
certificates under direct group policies and contracts, for supplemental
contracts to any of the preceding and for unallocated annuity contracts issued
by member insurers. (D) Delivery of summary
document Division (B)(2) of section 3956.18 of the Revised
Code provides that no member insurer shall deliver a policy or contract to a
policy owner, contract owner, certificate holder, or enrollee unless the
summary document is delivered to the policy or contract holder prior to or at
the time of delivery of the policy or contract. The document also shall be
available upon request by a policy owner, contract owner, certificate holder or
enrollee. (E) Disclaimer Division (C) of section 3956.18 of the Revised
Code provides that the summary document shall contain a clear and conspicuous
disclaimer on its face. (F) Form In providing the summary document and disclaimer
described in divisions (B)(2) and (C) of section 3956.18 of the Revised Code,
the insurer must use the exact form set forth in appendix I to this
rule. (G) Severability If any portion of this rule or the application
thereof to any person or circumstance is held invalid, the invalidity does not
affect other provisions or applications of the rule or related rules which can
be given effect without the invalid portion or application, and to this end the
provisions of this rule are severable.
Last updated November 16, 2023 at 8:29 AM
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Rule 3901-1-54 | Unfair property/casualty claims settlement practices.
Effective:
February 14, 2022
(A) Purpose The purpose of this rule is to set forth uniform
minimum standards for the investigation and disposition of property and
casualty claims arising under insurance contracts or certificates issued to
residents of Ohio. It is not intended to cover claims involving workers'
compensation, or fidelity, suretyship, and boiler and machinery insurance. The
provisions of this rule are intended to define procedures and practices which
constitute unfair claims practices. Nothing in this rule shall be construed to
create or imply a private cause of action for violation of this rule. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under sections 3901.041 and 3901.19 to
3901.26 of the Revised Code. (C) Definitions As used in this rule: (1) "Agent"
means any individual, corporation, association, partnership or other legal
entity authorized to represent an insurer with respect to a claim. (2) "Claim
file" means any retrievable electronic file, paper file, combination of
both, or any other media. (3) "Claimant"
means a first party claimant, a third party claimant. (4) "Contract"
means any insurance policy or document containing the terms of the agreement
wherein one party, the insurer, assumes certain obligations including financial
obligations that arise as a result of a loss sustained by another party, the
insured, or to any other party that has rights under the
agreement. (5) "Days"
means calendar days. However, when the last day of a time limit stated in this
rule falls on a Saturday, Sunday, or holiday, the time limit is extended to the
next immediate following day that is not a Saturday, Sunday, or
holiday. (6) "Department" means the Ohio department of
insurance. (7) "Documentation" includes, but is not limited to,
all communications, transactions, notes, work papers, claim forms, bills and
explanation of benefits forms pertaining to the claim. (8) "First party
claimant" means any individual, corporation, association, partnership or
other legal entity asserting a right to payment under an insurance policy or
insurance contract arising out of the occurrence of the contingency or loss
covered by the policy or contract. (9) "Insurer"
shall be defined as set forth in division (F) of section 3901.32 of the Revised
Code. (10) "Investigation" means all activities of an insurer
directly or indirectly related to the determination of liability under an
insurance contract which is in effect or alleged to be in effect. (11) "Like kind and
quality part" means a salvage motor vehicle part equal to or better than
the replaced part that is acquired from a licensed salvage motor
dealer. (12) "Notification
of claim" means any notification, under the terms of an insurance
contract, to an insurer or its agent, by a claimant, which reasonably apprises
the insurer of the facts pertinent to a claim. (13) "Person"
shall be defined as set forth in section 3901.19 of the Revised
Code. (14) "Practice"
means a type of activity or conduct engaged in by an insurer with such
frequency as to constitute a customary procedure or policy routinely followed
in the settlement of insurance claims. A single act is not a business practice.
However, an act that is malicious, deliberate, conscious and knowing may be the
basis for corrective action ordered only by the superintendent without a
showing that the conduct is a practice. (15) "Superintendent" means the
superintendent of insurance. (16) "Third party claimant"
means any individual, corporation, association, partnership or other legal
entity asserting a claim against any other individual, corporation,
association, partnership or legal entity. (17) "Proof of loss" means a
document from the claimant that provides sufficient information from which the
insurer can determine the existence and the amount of the claim. (D) File and record
documentation An insurer's claim files are subject to
examination by the superintendent of insurance or by the superintendent's
duly appointed designees. To aid in such examination: (1) An insurer shall
maintain claim data that is accessible and retrievable for examination. Such
data shall include number, line of coverage, date of loss and date of payment
or date of denial or date when claim is closed without payment. The data for
closed claims shall be kept for no less than three years or until the
completion of the next financial examination conducted by the state of
domicile, whichever is greater. Data for claims where the claims payment is
less than one thousand dollars, or for towing, labor, glass or rental
reimbursement may be kept in summary form. (2) An insurer must be
able to reconstruct its activities in regard to any claim, by documentation
appropriate for the type and size of the claim. If the claim is closed, the
time period for retention is set forth in paragraph (D)(1) of this
rule. (3) If an insurer does
not maintain hard copy files, claim files shall be accessible and be capable of
duplication to hard copy. (E) Misrepresentation of policy
provisions (1) An insurer shall
fully disclose to first party claimants all pertinent benefits, coverages or
other provisions of an insurance contract under which a claim is
presented. (2) No agent shall
willfully conceal from first party claimants benefits, coverages or other
provisions of any insurance contract when such benefits, coverages or other
provisions are pertinent to a claim. (3) No insurer shall deny
a claim based on the first party claimant's failure to make available for
inspection the property which is the subject of the claim unless there is
documentation of breach of the policy provisions in the claim
file. (4) No insurer shall deny
a claim based upon the failure of a first party claimant to give written notice
of loss within a specified time limit unless the notice is required by a policy
condition, or a first party claimant's failure to give written notice
after being requested to do so by the insurer is so unreasonable as to
constitute a breach of the claimant's duty to cooperate with the
insurer. (5) No insurer shall
indicate to a first party claimant on a payment draft, check or in any
accompanying letter that the payment is final or a release of any claim unless
the policy limit has been paid or the first party claimant and the insurer have
agreed to a compromise settlement regarding coverage and the amount payable
under the insurance contract. (6) No insurer shall
issue checks or drafts in partial settlement of a loss or claim under a
specific coverage that contains language purporting to release the insurer or
its insured from total liability. (F) Response to acknowledge receipt of
pertinent communications (1) Notification of a
claim given to an agent of an insurer shall be notification to the
insurer. (2) An insurer shall
acknowledge the receipt of a claim within fifteen days of receiving such
notification. An insurer may satisfy this requirement by making payment within
this fifteen day period. An insurer may also satisfy this requirement by
providing necessary claim forms and complete instructions to the claimant
within this fifteen day period. (3) An insurer shall
respond within fifteen days to any communication from a claimant, when that
communication suggests a response is appropriate. In the event that a complaint
has been filed by a claimant in any court, an insurer is not obligated to
respond within this time period and any communication between the claimant and
the insurer will be subject to the appropriate rule of procedure for the court
in which the lawsuit was filed. (4) An insurer shall,
within twenty-one days of receipt of an inquiry from the department regarding a
claim, furnish the department with a reasonable response to the
inquiry. (G) General standards for settlement of
claims (1) An insurer shall
within twenty-one days of the receipt of properly executed proof(s) of loss
decide whether to accept or deny such claim(s). If more time is needed to
investigate the claim than the twenty-one days allow, the insurer shall notify
the claimant within the twenty-one day period, and provide an explanation of
the need for more time. If an extension of time is needed, the insurer has a
continuing obligation to notify the claimant in writing, at least every
forty-five days, of the status of the investigation and the continued time for
the investigation. If the form and execution of a proof of loss is
material to an insurer, the insurer shall immediately provide the claimant with
the specific documents and specific instructions so the claimant can submit the
claim. An insurer shall not otherwise deny a claim solely on the basis the
proof of loss is not on the insurer's usual form. If an insurer reasonably believes, based upon
information obtained and documented within the claim file, that a claimant has
fraudulently caused or contributed to the loss as represented by a properly
executed and documented proof of loss, such information shall be presented to
the fraud division of the department within sixty days of receipt of the proof
of loss. Any person making such report shall be afforded such immunity and the
information submitted will be confidential as provided by sections 3901.44 and
3999.31 of the Revised Code. (2) No insurer shall deny
a claim on the grounds of a specific policy provision, condition or exclusion
unless reference to such provision, condition, or exclusion is included in the
denial. The claim file of the insurer shall contain documentation of the denial
in accordance with paragraph (D) of this rule. (3) Except as otherwise
provided by policy provisions, an insurer shall settle first party claims upon
request by the insured with no consideration given to whether the
responsibility for payment should be assumed by others. (4) No insurer shall
require an insured to submit to a polygraph examination unless authorized under
the applicable insurance contract. (5) Notice shall be given
to claimants at least sixty days before the expiration of any statute of
limitation or contractual limit, where the insurer has not been advised that
the claimant is represented by legal counsel. (6) An insurer shall
tender payment to a first party claimant no later than ten days after
acceptance of a claim if the amount of the claim is determined and is not in
dispute, unless the settlement involves a structured settlement, action by a
probate court, or other extraordinary circumstances as documented in the claim
file. (7) If a claim involves a
non-negligent party's property loss and multiple liability insurers, the
multiple liability insurers shall adjust the property loss within a reasonable
time and pay the non-negligent party's loss in equal shares. After
payment, the multiple liability insurers may then pursue available remedies to
resolve the question of responsibility for the non-negligent party's
loss. (8) If a claim involves
multiple coverages under any policy, no insurer shall withhold payment under
any such coverage when the payment is known, the payment is not in dispute, and
the payment would extinguish the insurer's liability under that coverage.
No insurer shall withhold such payment for the purpose of forcing settlement on
all other coverage to effect a single payment. (9) An insurer must
document the application of comparative negligence to any claim settlement.
Such information shall be fully disclosed to the claimant upon the
claimant's written request. An insurer shall not use pattern settlements
as set forth in division (P) of section 3901.21 of the Revised
Code. (10) An insurer shall not
use settlement practices that result in compelling first party claimants to
litigate by offering substantially less than the amounts claimed compared to
the amount ultimately recovered in actions brought by such
claimants. (H) Standards for prompt, fair and
equitable settlements of automobile insurance claims (1) When partial losses
will be settled on the basis of a written estimate prepared by or for an
insurer, the insurer shall supply the claimant a copy of the estimate upon
which the proposed settlement is based. If the claimant subsequently claims
that necessary repairs will exceed the written estimate, the insurer shall pay
the difference between the written estimate and a higher estimate obtained by
the claimant or promptly provide the claimant with the name of at least one
repair shop that will make the repairs for the amount of the written estimate.
If the insurer provides the name of only one repair shop, it shall ensure that
the repairs are performed in a workmanlike manner. The insurer shall maintain
documentation of all communications with the claimant pursuant to this
paragraph. (2) If an insurer reduces
a claim amount because of betterment, depreciation or comparative negligence,
it shall maintain all information pertaining to the reduction in the claim
file. Such deductions shall be itemized and specified on the written estimate
as to dollar amount and shall be appropriate for the amount of
deductions. (3) An insurer may reduce
a claim amount because of betterment deductions only if the deductions reflect
a measurable decrease in market value due to the poorer condition of, or prior
damage to, the vehicle; or reflect the general overall condition of the
vehicle, considering its age, for the wear and tear or rust, and/or missing
parts, limited to no more of a deduction than the replacement costs of part or
parts. (4) When partial losses
will be settled on the basis of a written estimate prepared by or for an
insurer, the estimate must clearly indicate the use of the parts in compliance
with section 1345.81 of the Revised Code. When like kind and quality parts are
expected to be used in the repair, the estimate shall clearly indicate the
location of the licensed salvage dealer where the like kind and quality parts
are to be obtained. (5) An insurer which
elects to repair and designates a specific repair shop for automobile repairs
shall cause the damaged automobile to be restored to its condition prior to the
loss. The insurer shall assess no additional cost against the claimant other
than as stated in the policy, and the repairs should be effected within a
reasonable period of time. (6) In settlement of
claimants' automobile total losses on the basis of actual cash value or
replacement of the automobile with another vehicle of like kind and quality, an
insurer which elects to offer a replacement automobile shall: (a) Provide an automobile by the same manufacturer, of the same
or newer year, of similar body style, with similar options and mileage as the
claimant's vehicle and in as good or better overall condition than the
first party automobile prior to loss; (b) Ensure that the automobile is available for inspection within
a reasonable distance of the claimant's residence; (c) Pay all applicable taxes, license fees, and other fees
incident to transfer of evidence of ownership of the automobile at no cost to
claimant other than any deductible provided in the policy; and (d) Document the offer of the replacement automobile and any
rejection of the offer in the claim file. (7) In settlement of
claimants' automobile total losses on the basis of actual cash value or
replacement of the automobile with another of like kind and quality, an insurer
which elects to offer a cash settlement to claimant shall base the offer upon
the actual cost to purchase a comparable automobile less any applicable
deductible amount contained in the policy, and/or deduction for betterment as
contained in paragraph (H)(2) of this rule. The settlement value may be derived
from: (a) The average cost of two or more comparable automobiles in the
local market area if comparable automobiles are or were available to consumers
within the last ninety days; or (b) The average cost of two or more comparable automobiles in
areas proximate to the local market area, including the closest in-state or
out-of-state major metropolitan areas, that are or were available to consumers
within the last ninety days if comparable automobiles are not available
pursuant to paragraph (H)(7)(a) of this rule; or (c) The average of two or more quotations obtained by the insurer
from two or more licensed dealers located within the local market area if
comparable automobiles are not available pursuant to paragraphs (H)(7)(a) and
(H)(7)(b) of this rule; or (d) The cost as determined from a generally recognized used motor
vehicle industry source such as: (i) An electronic
database if the pertinent portions of the valuation documents generated by the
database are provided by the insurer to the claimant upon request;
or (ii) A guidebook that is
generally available to the general public if the insurer identifies the
guidebook used as the basis for the cost to the claimant upon request, and to
which appropriate adjustments for condition, mileage and major options are made
and documented in the claim file. (e) Any method or source chosen as specified in paragraph
(H)(7)(d) of this rule shall be used consistently over a period of time by the
insurer. (f) If within thirty days of receipt by the claimant of a cash
settlement for the total loss of an automobile, the claimant purchases a
replacement automobile, the insurer shall reimburse the claimant for the
applicable sales taxes incurred on account of the claimant's purchase of
the automobile, but not to exceed the amount that would have been payable by
the claimant for sales taxes on the purchase of an automobile with a market
value equal to the amount of the cash settlement. If the claimant purchases an
automobile with a market value less than the amount of the cash settlement, the
insurer shall reimburse only the actual amount of the applicable sales taxes on
the purchased automobile. If the claimant cannot substantiate such purchase and
the payment of such sales taxes by submission to the insurer of appropriate
documentation within thirty-three days after receipt of the cash settlement,
the insurer shall not be required to reimburse the claimant for such sales
taxes. In lieu of reimbursement, the insurer may pay directly the applicable
sales taxes to the claimant at the time of the cash settlement. An insurer that settles a total loss on a
cash settlement basis must maintain in the claim file the documentation used to
determine the loss. Such information shall be provided to the first party
claimant upon request. An insurer shall notify the first party claimant of any
rights to renegotiate the settlement if a comparable vehicle is not available
for purchase within thirty-five days of receipt of the settlement. When an insurer elects to offer a replacement
vehicle available to the claimant, the insurer shall provide all the details
where such vehicle is available including the vehicle identification
number. (g) An insurer that settles a total loss claim shall provide
written notice to the claimant of the right to reimbursement of applicable
sales tax as specified in paragraph (H)(7)(f) of this rule. The notice shall be
issued to the claimant simultaneously with the conveyance of the settlement
check to the claimant. If an insurer elects to pay the applicable sales taxes
directly to the claimant at the time of the cash settlement in lieu of
reimbursement as provided in paragraph (H)(7)(f) of this rule, the insurer is
not required to provide written notice of the claimant's right to sales
tax reimbursement. (8) An insurer shall not
require a claimant to travel an unreasonable distance to inspect a replacement
automobile, to obtain a repair estimate, or to have the automobile repaired at
a specific repair shop. (9) An insurer shall
provide notice to a claimant prior to termination of payment for automobile
storage charges. The insurer shall document all actions taken pursuant to this
paragraph in accordance with paragraph (D) of this rule. (10) An insurer shall
include the first party claimant's deductible, if any, in subrogation
demands. The insurer shall share any subrogation recovery received on a
proportionate basis with the first party claimant, unless the first party
claimant's deductible has been paid in advance or recovered. The insurer
shall not deduct expenses from this amount except that an outside attorney or
collection agency retained to collect such recovery may be paid a pro rata
share of his expenses for collecting this amount. (I) Standards for prompt, fair and
equitable settlement of claims under fire and extended coverage insurance
policies (1) If a fire and
extended coverage insurance policy provides for the adjustment and settlement
of first party losses based on replacement cost, the following shall
apply: (a) When a loss requires replacement of an item or part, any
consequential physical damages incurred in making such repair or replacement
not otherwise excluded by the policy, shall be included in the
loss. (b) When an interior or exterior loss requires replacement of an
item and the replaced item does not match the quality, color or size of the
item suffering the loss, the insurer shall replace as much of the item as to
result in a reasonably comparable appearance. (c) When an insurer settles a loss that results in the insured
paying a portion of the repair or replacement as betterment, the insurer shall
maintain documentation of the basis for computing the betterment charge, and
the insured's agreement to such charge prior to incurring the expense of
the repair or replacement. (2) If a fire and
extended coverage insurance policy provides for the adjustment and settlement
of losses on an actual cash value basis, the following shall
apply: (a) The insurer shall determine actual cash value by determining
the replacement cost of property at the time of loss, including sales tax, less
any depreciation. Upon the insured's request, the insurer shall provide
documentation detailing all depreciation deductions. (b) If the insured's interest is limited because his
property has nominal or no economic value, or a value disproportionate to
replacement cost less depreciation, the insurer is not required to comply with
paragraph (I)(2)(a) of this rule regarding the determination of actual cash
value. However, the insurer shall provide upon the insured's request, a
written explanation of the basis for limiting the amount of recovery along with
the amount payable under the policy. (J) Applicability of rule 3901-1-07 of the Administrative
Code If any provisions of any section of this rule
conflicts with any of the provisions contained in rule 3901-1-07 of the
Administrative Code, the provisions of this rule will apply. (K) Imposition of fine Pursuant to section 3901.22 of the Revised Code
and a consent agreement with the insurer, the superintendent may recover the
cost of an investigation under this rule and/or a penalty from the
insurer. (L) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated February 14, 2022 at 8:55 AM
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Rule 3901-1-55 | Use of Credit history and credit scores.
Effective:
March 20, 2008
(A) Authority This rule is issued pursuant to section 3901.041 of the Revised Code which provides 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, including, but not limited to, the superintendent's duties and powers under Chapters 1751. and 1753. and Title XXXIX of the Revised Code, subject to Chapter 119. of the Revised Code. Sections 3901.20 and 3901.21 of the Revised Code prohibit unfair or deceptive practices in the business of insurance and define certain acts or practices as unfair or deceptive. Section 3901.21 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 section 3901.21 or to take action under other sections of the Revised Code. (B) Purpose The purpose of this rule is to clearly define certain unfair practices and to set forth standards with respect to insurers' and agents' use of credit history and credit scores in connection with underwriting and rating personal lines coverage. (C) Scope This rule applies only to personal lines coverage as defined in paragraph (D)(6) of this rule. (D) Definitions As used in this rule: (1) "Adverse action" has the same meaning as defined in the Fair Credit Reporting Act, 15 U.S.C. 1681 et seq. (1998), and includes a denial or cancellation of, an increase in any charge for, or a reduction or other adverse or unfavorable change in the terms of coverage or amount of, any insurance, existing or applied for, in connection with the underwriting or rating of insurance. Issuance of a policy at a rate higher than that which the consumer would have received if the consumer's credit history had not been taken into account is an adverse action. (2) "Consumer" means any insured or applicant for personal lines coverage. (3) "Credit history" means any written, oral, or other communication of any information bearing on a consumer's creditworthiness, credit standing, or credit capacity that is used or expected to be used, or collected in whole or in part, for the purpose of serving as a factor in determining rates, placement within a tier or with an affiliated company, or eligibility for coverage. (4) "Credit score" means a number or rating that is derived from an algorithm, computer application, model or other process that is based in whole or in part on credit history. (5) "Insurance score" and "credit based insurance score" have the same meaning: a number or rating that is derived from an algorithm, computer application, a model or other process that is based in whole or in part on a credit score or credit history, for the purpose of predicting the future insurance loss exposure of a consumer (that is, any insured or applicant). (6) "Personal lines" means a policy of property and casualty insurance issued to a natural person primarily for personal or family protection for personal automobile, homeowner's, tenant's, mobile-homeowner's, non-commercial dwelling fire or personal umbrella coverage. (7) "Consumer reporting agency" means any person which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for purposes of furnishing such information to third parties. (E) Credit cannot be the sole underwriting or rating factor Credit history or a credit score or any aspect thereof, either individually or collectively, may not be used without consideration of any other applicable underwriting or rating factor as the sole basis for: (1) Any underwriting decision; (2) Any total premium determination; or (3) Any adverse action. This paragraph does not prohibit an insurer from raising a premium rate at renewal based on a change in credit history, in a credit score, or in the actuarial indications for a particular credit history or credit score if other non-credit related factors are also considered in the total premium determination. (F) Prohibited underwriting, rating and credit scoring factors No insurer underwriting or rating a policy of personal lines insurance shall use any of the following as a negative factor in any credit scoring methodology or in reviewing the credit history of any consumer: (1) Credit inquiries not initiated by the consumer; (2) Credit inquiries relating to insurance coverage; (3) Disputed information that is currently under investigation by the consumer reporting agency, if so identified on the records of such agency; (4) Collection accounts with a medical industry code, if so identified on the records of the consumer reporting agency; (5) Multiple lender inquiries, if coded by the consumer reporting agency on the consumer's credit report as being from the home mortgage industry and made within thirty days of one another, unless only one inquiry is considered; or (6) Multiple lender inquiries, if coded by the consumer reporting agency on the consumer's credit report as being from the automobile lending industry and made within thirty days of one another, unless only one inquiry is considered. (G) Disclosure requirements (1) The consumer must be provided notice either prior to or at the time the insurance application is taken that credit history or a credit score may be obtained and used in connection with underwriting or rating a policy. Such notice shall either be written or provided to the consumer in the same medium as the application for insurance. The insurer need not provide such notice to any insured on a renewal policy, if such notice has previously been provided. (2) If an adverse action is taken as a result of credit history or a credit score the following disclosures must be made to the consumer in writing within thirty days of the date the adverse action is taken: (a) The insurer must identify and describe the nature of the adverse action; (b) The insurer must describe the significant factors of the credit history or credit score that resulted in the adverse action, which may include the descriptive credit explanations provided by credit scoring vendors; and (c) The insurer must provide the consumer with all disclosures required by the Fair Credit Reporting Act, 15, U.S.C. 1681 et seq. (1998). Such disclosures shall include: (i) The name, address, and telephone number of the consumer reporting agency (including a toll-free telephone number established by the agency if the agency compiles and maintains files on consumers on a nationwide basis) that furnished the consumer information; (ii) A statement that the consumer reporting agency did not make the decision to take the adverse action and is unable to provide the consumer with the specific reasons why the adverse action was taken; (iii) Notice to the consumer of the consumer's right to obtain a free copy of the consumer's credit report from the consumer reporting agency; and (iv) Notice to the consumer of the consumer's right to dispute with the consumer reporting agency the accuracy or completeness of any information in a credit report furnished by the agency. (H) Updating credit history and credit scores (1) If credit history or a credit score, or any aspect thereof, is considered in underwriting or rating a consumer and a consumer reporting agency determines that the credit information is inaccurate or incomplete and the insurer receives notice of this determination from a consumer or a consumer reporting agency, the insurer shall, within thirty days after receiving the notice: (a) Re-underwrite the consumer; (b) Re-rate the consumer; and (c) Adjust the premium as indicated in paragraph (H)(2) of this rule. (2) If it is determined by the re-underwriting or re-rating in accordance with paragraph (H)(1) of this rule that the consumer has overpaid the premium, the insurer shall refund to the consumer the amount of the overpayment of premium. Such payment shall be calculated back to the shorter of: (a) The last twelve months of coverage; or (b) The current policy term. (3) After any policy of insurance has been issued and in the absence of a determination of the consumer reporting agency that the consumer's information is inaccurate or incomplete as described in paragraph (H)(1) of this rule, the insurer must recheck the insured's credit history or credit score at the written request of the insured, but no more than once every twelve months. The insurer may wait to recheck the credit information until the next renewal. The insurer shall adjust the premium or coverage of any insured whose credit history or credit score was rechecked under this section that reflects any change in the insured's credit history or credit score. Any such premium or coverage adjustment shall be applied prospectively to the next policy term. (I) Compliance with rule (1) Section 3901.20 of the Revised Code prohibits insurers from engaging in unfair or deceptive acts. Section 3901.21 of the Revised Code defines as an unfair and deceptive act the following unfair discriminatory conduct: Making or permitting any unfair discrimination between individuals of the same class and of essentially the same hazard in the amount of premium, policy fees, or rates charged for any policy or contract of insurance, other than life insurance, or in the benefits payable thereunder, or in underwriting standards and practices or eligibility requirements, or in any of the terms or conditions of such contract, or in any other manner whatever. (2) Division (A) of section 3937.02 and division (C) of section 3935.03 of the Revised Code set forth the factors an insurer or rating organization may consider in establishing rates for property and casualty insurance. Division (C) of section 3937.02 of the Revised Code provides that risks may be grouped by classification for the establishment of rates and minimum premiums, and states: Classification rates may be modified to produce rates for individual risks in accordance with rating plans which establish standards for measuring variations in hazards or expense provisions, or both. Such standards may measure any differences among risks that can be demonstrated to have a probable effect upon losses or expenses. (3) Division (D) of section 3937.02 of the Revised Code further provides: "Rates shall not be excessive, inadequate, or unfairly discriminatory." In order to comply with the foregoing paragraphs, insurers shall abide by the following guidelines: (a) Insurers shall establish that credit history and credit scores used in underwriting or rating determinations are valid risk characteristics and are used in accordance with actuarial principles and standards of practice. (b) If a consumer has no available credit history (known as a "no hit"), has insufficient credit history to develop a credit score (known as "no score"), or the available credit history is not used for rating, the consumer must be underwritten and rated in accordance with actuarial principles and standards of practice. (c) Insurers shall not use credit history or credit scores for arbitrary, capricious or unfairly discriminatory purposes. Credit history and credit scores shall not be based on race, color, religion, national origin, sex, marital status, handicap, or age. (d) Insurers must maintain, implement and make available standards concerning how credit history and credit scores affect underwriting and rating decisions. Insurers shall file with the superintendent all risk classification criteria and rating manuals that relate to credit history and credit scores. (e) If a credit scoring model is modified or if its use in determining rates or rating plans is modified, the insurer shall re-file risk classification criteria and rating manuals with the superintendent, and shall re-establish that the credit scores are valid risk characteristics and are used in accordance with actuarial principles and standards of practice. . (J) Severability If any provision of this rule or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the rule and the application of the remaining provisions to such persons or circumstances shall not be affected thereby.
Last updated October 11, 2023 at 1:48 PM
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Rule 3901-1-57 | Transaction fees.
(A) Purpose The purpose of this rule is to establish fees and charges for certain transactions or services performed by the department of insurance. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under sections 3901.041, 3901.043, 3901.07, and 3913.37 of the Revised Code. (C) The following schedule of fees is established for transactions and services performed under the following: (1) Transactions pursuant to section 3901.321 of the Revised Code: (a) Filing of the statement (form A) relating to the change of control or takeover of a domestic insurance company. Twenty-five hundred dollars. (b) Filing for an exemption from the requirements of section 3901.321 of the Revised Code. One thousand dollars. (2) Transactions pursuant to section 3901.341 of the Revised Code: Filing of any transaction (form D) required by this paragraph. Two hundred fifty dollars. (3) Transactions pursuant to Chapter 3905. of the Revised Code: (a) Filing of a notice of appointment of an agent, including the renewal of an agent at the time of annual renewal. Ten dollars/per appointment. (b) Filing for authority to conduct business as a surplus lines insurer. One thousand dollars/annually. (4) Transactions pursuant to section 3907.12 of the Revised Code: Filing for approval of a plan of reinsurance that exceeds the limits set forth in section 3907.12 of the Revised Code, or a plan of assumption reinsurance on policies issued by a domestic insurance company. Fifteen hundred dollars. (5) Transactions pursuant to sections 3911.011, 3915.14, 3917.06, 3918.07, and 3923.02 of the Revised Code: Any filing required to be submitted to the superintendent. Fifty dollars per insurer/per filing. Multiple forms relating to a single policy may be filed together for one fifty dollar fee, otherwise, each form filed is considered a separate filing and a fifty dollar fee applies to each. (6) Transactions pursuant to sections 3913.01 to 3913.38 of the Revised Code: (a) Filing of a plan of conversion of a domestic stock life insurance corporation into a mutual insurance corporation. Twenty-five hundred dollars. (b) Filing of a plan of conversion of a domestic mutual life insurance company to a stock life insurance company. Twenty-five hundred dollars. (c) Filing of a plan of conversion of a non-life mutual insurance company to a stock non-life insurance company. Twenty-five hundred dollars. (d) Filing of a plan of reorganization or merger of a mutual insurance company or mutual insurance holding company. Twenty-five hundred dollars. (7) Transactions pursuant to section 3913.40 of the Revised Code: Filing of a plan to transfer the domicile of an insurance company either to or from the state of Ohio. Twenty-five hundred dollars. (8) Transactions pursuant to section 3935.04 of the Revised Code: (a) Any filing required to be submitted to the superintendent. Fifty dollars per insurer/per filing. Multiple forms relating to a single policy may be filed together for one fifty dollar fee, otherwise, each form or policy is considered a separate filing and a fifty dollar fee applies to each. (b) Any excess rate filing required to be submitted to the superintendent pursuant to division (G) of section 3935.04 of the Revised Code is exempt from the filing fee. (9) Transactions pursuant to section 3937.03 of the Revised Code: (a) Any filing required to be submitted to the superintendent. Fifty dollars per insurer/per filing. Multiple forms relating to a single policy may be filed together for one fifty dollar fee, otherwise, each form or policy is considered a separate filing and a fifty dollar fee applies to each. (b) Any special filing pursuant to division (E) of section 3937.03 of the Revised Code and any excess rate filing pursuant to division (G) of section 3937.03 of the Revised Code that are required to be submitted to the superintendent are exempt from the filing fee. (D) Whenever another state or jurisdiction charges a greater fee for a transaction listed in this rule to an insurer domiciled in Ohio, then the superintendent may charge that higher fee to the insurer not domiciled in Ohio, who seeks to have the transaction completed in this state. (E) (1) The department will invoice the insurer for the fee charged for the transactions listed in paragraph (C)(3) of this rule. (2) Fees charged for the transactions listed in paragraphs (C)(1), (C)(2), (C)(4), (C)(6) and (C)(7) of this rule shall be submitted with the first documents sent to the department. (3) Fees charged for the transactions listed in paragraphs (C)(5), (C)(8) and (C)(9) of this rule shall be paid via the "EFT" functionality built into the "System for Electronic Rates and Forms Filing" commonly known as "SERFF." (4) All fees collected pursuant to this rule shall be deposited to the credit of the department of insurance operating fund created pursuant to section 3901.021 of the Revised Code. (F) (1) For purposes of this paragraph, "expenses" has the same meaning as set forth in division (M) of section 3901.07 of the Revised Code. (2) Expenses incurred from the conduct of a financial examination authorized by division (B) of section 3901.07 of the Revised Code will be billed directly to the insurer. (a) Such expenses authorized by division (M)(4) of section 3901.07 of the Revised Code are calculated at 0.96 of the amount assessed pursuant to division (M)(1)(a) of section 3901.07 of the Revised Code. (b) Such expenses billed to the insurer are due upon the insurer's receipt of an invoice from the department pursuant to division (L) of section 3901.07 of the Revised Code. (3) Expenses incurred pursuant to divisions (M)(1)(b) to (M)(1)(f) and (M)(4) of section 3901.07 of the Revised Code apart from the conduct of a financial examination authorized by division (B) of section 3901.07 of the Revised Code are assessed annually to the insurer. (a) Such expenses for each domestic insurer are established pursuant to the following schedule, provided that the total amount due from an insurance holding company system with more than one domestic insurer is not to exceed one hundred twenty-five thousand dollars in the aggregate: Annual Countrywide Direct Premiums Written | Total Amount Due | $100,000,000 or Greater | $29,000 | $50,000,000 to $99,999,999 | $19,000 | $25,000,000 to $49,999,999 | $16,000 | $10,000,000 to $24,999,999 | $13,000 | $5,000,000 to $9,999,999 | $6,000 | $500,000 to $4,999,999 | $1,600 | Less Than $500,000 | $500 |
(b) Such expenses billed to the insurer are due upon the insurer's receipt of an invoice from the department. (G) Severability If any portion of this rule or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the rule or related rules which can be given effect without the invalid portion or application, and to this end the provisions of this rule are severable.
Last updated July 27, 2023 at 9:02 AM
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Rule 3901-1-58 | Standard credentialing form for physician and non-physician providers.
Effective:
November 16, 2023
(A) Purpose The purpose of this rule is to prescribe the
standard credentialing form to be used when credentialing or recredentialing
providers. For purposes of this rule, the term "providers" has the
same meaning as in division (P) of section 3963.01 of the Revised Code. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under sections 3901.041, 3901.21, and
3963.08 of the Revised Code. (C) Form All credentialing and recredentialing of
physicians and non-physician individual providers identified in division (P) of
section 3963.01 of the Revised Code is to be performed using the credentialing
form available from the council for affordable quality healthcare (CAQH) in
electronic or paper format. The CAQH credentialing form is referred to as the
department of insurance part A credentialing form. Copies of this form may be
obtained electronically from CAQH or from the department of insurance. The
department of insurance part B credentialing form is used to credential hearing
aid dealers, home health agencies, hospice care providers and all other
providers, with the exception of hospitals, that are not individuals. Copies of
this form may be obtained from the department of insurance. The credentialing
forms prescribed by this rule may be reproduced as needed and may be amended
from time to time. (D) Severability If any portion of this rule or the application
thereof to any person or circumstance is held invalid, the invalidity does not
affect other provisions or applications of the rule or related rules which can
be given effect without the invalid portion or application, and to this end the
provisions of this rule are severable.
Last updated November 16, 2023 at 8:29 AM
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Rule 3901-1-64 | Medical liability data collection.
Effective:
November 10, 2014
(A) Purpose The purpose of this rule is to establish procedures and requirements for the reporting of specific medical, dental, optometric and chiropractic claims data to the Ohio department of insurance. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under sections 3901.041 and 3929.302 of the Revised Code. (C) Definitions (1) "Medical, dental, optometric and chiropractic claims" include those claims asserted against a risk located in this state that either: (a) Meet the definition of "medical claim," "dental claim," "optometric claim," or "chiropractic claim" in section 2305.113 of the Revised Code, or (b) Have not been asserted in any civil action, but that otherwise meet the definition of "medical claim," "dental claim," "optometric claim," or "chiropractic claim" in section 2305.113 of the Revised Code. (2) "Risk retention group" has the same meaning as in section 3960.01 of the Revised Code. (3) "Surplus lines insurer" means an insurer that is not licensed to do business in this state, but is nonetheless approved by the department to offer insurance because coverage is not available through licensed insurers. (4) "Self-insurer" means any person or persons who set aside funds to cover liability for future medical, dental, optometric or chiropractic claims or that otherwise assume their own risk or potential loss for such claims. "Self-insurer" includes captives. (D) Each authorized insurer, surplus lines insurer, risk retention group, self-insurer, the medical liability underwriting association if created under section 3929.63 of the Revised Code, or any other entity that offers medical malpractice insurance to, or that otherwise assumes liability to pay medical, dental, optometric or chiropractic claims for, risks located in this state, shall report at least annually to the superintendent of insurance, or to the superintendent's designee, information regarding any medical, dental, optometric, or chiropractic claim asserted against a risk located in this state, if the claim resulted in: (1) A final judgment in any amount, (2) A settlement in any amount, or (3) A final disposition of the claim resulting in no indemnity payment on behalf of the covered person or persons. (E) The report required by paragraph (D) of this rule shall include for each claim: (1) The name, address and specialty coverage of each covered person; (2) The insured's policy number, if applicable; (3) The date of the occurrence that created the claim; (4) The name and address of the injured person; (5) The date the claim was reported and the claim number; (6) The injured person's age and sex; (7) If the medical, dental, optometric, or chiropractic claim was filed with the court, the case number and the name and location of the court; (8) In the case of a judgment, the date and amount of the judgment and, if the judgment is subject to the itemization requirements in division (B) of section 2323.43 of the Revised Code, a description of the portion of the judgment that represents economic loss, non-economic loss and punitive damages, if any; (9) In the case of a settlement, the date and amount of the settlement and, if known, the injured person's incurred medical expense, wage loss, and other expenses; (10) Any loss adjustment expenses allocated to the claim or, if known, the amount allocated to each covered person; (11) The loss adjustment expense, broken down between fees and expenses, paid to defense counsel; (12) The date and reason for final disposition, if no judgment or settlement, and the type of disposition; (13) Unless disclosure is otherwise prohibited by state or federal law, a summary of the occurrence which created the claim which shall include: (a) The name of the institution, if any, and the location at which the injury occurred; (b) The operation, diagnosis, treatment, procedure or other medical event or incident giving rise to the alleged injury; (c) A description of the principal injury giving rise to the claim. (F) Frequency The report(s) required by this rule shall be filed with the superintendent, or the superintendent's designee, on or before May first of each year, and shall contain information for the previous calendar year. (G) Noncompliance Any person listed in paragraph (D) of this rule that fails to timely submit the report required under this section shall be subject to a fine not to exceed five hundred dollars. (H) Confidentiality Information reported to the superintendent or the superintendent's designee pursuant to this rule shall be confidential and privileged and is not a public record as defined in section 149.43 of the Revised Code. The information provided under this section is not subject to discovery or subpoena and shall not be made public by the superintendent or any other person, including any rating organizations or other agencies designated by the superintendent to gather and/or compile the information. (I) The requirements of this rule do not apply to reinsurers, reinsurance contracts, reinsurance agreements, or reinsurance claims transactions. (J) Severability If any paragraph, term or provision of this rule is adjudged invalid for any reason, the judgment shall not affect, impair or invalidate any other paragraph, term or provision of this rule, but the remaining paragraphs, terms and provisions shall be and continue in full force and effect.
Last updated October 11, 2023 at 1:48 PM
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Rule 3901-1-65 | Medical Malpractice Annual Filing Requirements.
Effective:
March 26, 2006
(A) Purpose The purpose of this rule is to safeguard the interest of the public by allowing reasonable inspection and analysis of insurers' rating plans on an annual basis for the regulation and monitoring of medical malpractice premium rates. (B) Authority This rule is adopted pursuant to the authority vested in the superintendent under sections 3901.041, 3937.04 and 3937.12 of the Revised Code. (C) Annual rate filing requirement (1) Every insurer issued a certificate of authority to write medical malpractice insurance in this state and that issues such insurance in this state, shall at a minimum, file annually with the superintendent of insurance, appropriate information and exhibits, in support of the insurer's existing rating plan. If at any time the superintendent of insurance finds that a rate no longer complies with sections 3937.01 to 3937.17 of the Revised Code, the superintendent may, in accordance with section 3937.04 of the Revised Code, state that the rate shall no longer be effective. (2) In lieu of the filing required in paragraph (C)(1) of this rule a carrier may annually file for a rate adjustment in accordance with section 3937.03 of the Revised Code. (3) Included with a filing required in paragraph (C)(1) or (C)(2) of this rule, every insurer that issues medical malpractice insurance in this state, shall file the average, minimum, and maximum deviation from manual rates due to individual risk premium modifications, also known as schedule rating credits and debits, or discretionary credits and debits, applied by the insurer during a twelve month period which ends no more than six months before the date of the filing. If at any time the superintendent of insurance finds that the credits and debits exceed the maximum allowed or may result in inadequate rates or be destructive of competition or detrimental to solvency of insurers, the superintendent may in accordance with section 3937.04 of the Revised Code state that the rate shall no longer be effective. (4) The first filing under paragraph (C)(1) or (C)(2) of this rule is due within twelve months of the effective date of this rule. (D) Superintendent's discretionary authority Extensions of time for the filing required under paragraph (C) of this rule may be granted by the superintendent upon a showing by the insurer the reasons for requesting such extension and a determination by the superintendent of good cause for the extension. The request for an extension must be submitted in writing not less than ten days prior to the due date of the required filing. (E) Severability Each paragraph of this rule and every part of each paragraph is an independent paragraph and part of a paragraph, and the determination that any paragraph or subpart of this rule or the application thereof to any person or circumstance is for any reason held invalid, such invalidity shall not affect any other paragraph or subpart or application of the rule that can be given effect without the invalid provision or application.
Last updated October 11, 2023 at 1:48 PM
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Rule 3901-1-66 | Surety bail bond agent conduct.
Effective:
December 8, 2022
(A) Purpose. The purpose of this rule is to establish
criteria for surety bail bond agent conduct. (B) Authority. This rule is promulgated pursuant to the
authority vested in the superintendent under sections 3901.041 and 3905.95 of
the Revised Code. (C) Definitions. As used in this rule: (1) "Cash bond" means the full amount of the bail required
to be paid in cash to release a defendant from jail. (2) "Power of attorney" means a legal instrument that is
used by a authorized surety company to delegate authority to a licensed general
agent or surety bail bond agent for the posting of surety bail bonds with a
court of law up to a specified monetary amount. (3) "Surety bail bond" means a court accepted bond
instrument from a licensed insurance company issued for or on behalf of an
incarcerated person held under criminal charges in any Ohio mayor, municipal,
county, or federal court. (4) "Immigration bond" means a federally accepted bond
instrument from a surety company approved by the United States department of
treasury issued for and on behalf of alien detainees held by United States
immigration and customs enforcement, within the department of homeland security
pending a hearing or court appearance; or to guarantee that an alien will be
financially independent during a lawful visit or prolonged stay to the United
States. (D) Stacking bonds prohibited. A surety bail bond agent shall not submit more
than one power of attorney for any single bond, charge or charges, as is
assigned a number by a court of proper jurisdiction. (E) Submitting powers and bonds (1) All surety bail bonds submitted to the court or the
custodian of an arrested person must be accompanied by a current, non-expired,
legal power of attorney. (2) Only one power of attorney shall be submitted per bond.
The face value of the power shall be equal to or greater than the amount of the
bond set by the court in the single charge or charges for which the bond and
power are being submitted. (3) No power of attorney that has been altered or erased
shall be submitted to a court or insurance company. (4) No expired power of attorney shall be submitted to a
court or insurance company. (5) No power of attorney shall be used or submitted to a
court or insurance company more than once. (F) Immigration bonds Immigration bonds may be solicited, sold, or
negotiated only by: (1) A person holding an Ohio insurance license with a
casualty line of authority conferred pursuant to Title 39 of the Revised
Code. (2) A person holding an Ohio surety bail bond line of
authority conferred pursuant to Title 39 of the Revised Code, who has been
given a bond power that expressly allows for the writing of an immigration
bond. (G) Bond money from loan companies No surety bail bond agent shall be employed by,
contracted with, or act as an agent for, or own an ownership interest in any
person or business entity that loans money for, or takes collateral for the
loan of money for, the purpose of posting a cash bond or surety bail bond on
behalf of a defendant. (H) Real property as collateral When accepting real property as collateral for a
bond, (1) A surety bail bond agent shall not require the transfer
of title of any real property as a condition of issuing the bail
bond. (2) A surety bail bond agent may require a defendant, or
anyone agreeing to provide real property as collateral on a defendants behalf,
to establish title and unencumbered value, at the defendants expense, together
with mortgage security or other documents necessary to establish the surety
bail bond agent's lien interest in the real property by the bail
agent. (3) A surety bail bond agent shall not provide title,
notary, or lien filing services directly or indirectly to the client or
defendant for a fee. A surety bail bond agent shall not receive any valuable
consideration for referring a person for title, notary, or lien filing
services. (4) Return of security document collateral: (a) If the security document has not been filed with the
state or a division of the state to perfect the lien, and the bond has not been
called or otherwise needed or used, the original mortgage or other security
document must be stamped cancelled and returned to the client or defendant
within twenty-one days from the end of the bond. (b) If the security document has been filed with the state
or a division of the state to perfect the lien, and the bond has not been
called or otherwise needed or used, a release of the mortgage or release of the
other security document must be completed within twenty-one days after the end
of the bond. A copy of the release containing an official date/time stamp must
be provided to the client within twenty-six days after the end of the
bond. (I) Solicitation (1) The following activities shall constitute prohibited
solicitation by a surety bail bond agent on the grounds of a courthouse or
detention facility: (a) Approaching a person not currently a client and in any
way initiating communication concerning bail bond services. (b) Writing bonds for an individual without their direct
knowledge and consent. (c) Communicating as, or holding oneself out to be, a court
appointed surety bail bond agent or suggesting in any manner that one has been
appointed by a court or other public agency to write a bond for a particular
defendant, or on a particular case. (d) Wearing clothing that indicates a person is in the bail
bond industry unless otherwise directed by the court or detention facility,
except the wearing of the issued department of insurance ID card. (e) Conducting business in a loud and conspicuous
manner. (f) Distributing a business card, pen, or any other item,
that identifies an individual or business entity as providing surety bail bond
services. (g) Physically impeding, blocking, or hindering the public
from viewing or obtaining the docket or other information needed to ascertain
the status or procedure of any court process including all court bonding
processes. (h) Engaging or hiring any person, directly or indirectly,
to perform any acts listed in paragraphs (I)(1)(a) to (I)(1)(g) of this
rule. (i) Any other activity that may be construed as the sale or
solicitation of surety bail bonds. (2) The following activities shall not constitute
prohibited solicitation by a surety bail bond agent on the grounds of a
courthouse or detention facility subject to the limitations of paragraph (I)(1)
of this rule: (a) Having personal business matters before a court or
detention facility; (b) Attending a scheduled hearing or meeting with any
person(s) regarding surety bail bonds as long as the meeting is arranged with
the person(s) prior to the arrival at the courthouse or detention
facility; (c) Being retained by a person to write and post a surety
bail bond; (d) Gathering court and docket information for business
purposes; (e) Writing a bond and posting a bond with the
court; (f) Returning a fugitive from justice pursuant to section
2927.27 of the Revised Code; (g) Notifying a court, or detention facility of
professional activities being conducted by the surety bail bond agent, other
than solicitation; or (h) Filing required paperwork with the court or detention
facility regarding bonds, prisoners, bail bond license status, or
fugitives. (J) Severability If any section, term or provision of this rule is
adjudged invalid for any reason, such judgment shall not affect, impair or
invalidate any other section, term or provision of this rule, but the remaining
sections, terms and provisions shall be and continue in full force and
effect.
Last updated December 8, 2022 at 8:35 AM
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Rule 3901-1-67 | Alternative derivative and reserve accounting practices.
Effective:
April 15, 2021
(A) Purpose The purpose of this rule is to allow insurance
companies to utilize certain alternative derivative and reserve accounting
practices for eligible derivative instruments and indexed products,
respectively, in order to better match derivative and reserve accounting as it
relates to interest crediting for indexed products and to provide for a more
true and fair representation of the capital position and net gain from
operations of insurance companies that offer or have in force indexed products.
Specifically, this rule addresses the mismatches related to the changes in
value of an eligible derivative instrument as compared to the interest accrual
in the reserve calculation for the underlying indexed product in two ways. This
rule provides insurance companies with the ability, once certain criteria are
met, to: (1) account for eligible derivative instruments using the amortized
cost method, and (2) make an election at a policy level to use a reserve
calculation methodology for indexed annuity products under which interest
credits based upon one or more external indices are included in the reserve
only after those interest credits have been credited to the contract holder
under the terms of the annuity contract. In addition, regardless of the use of
the ability provided for in the previous sentence, this rule provides insurance
companies with the ability to record changes in, and settlement of, eligible
derivative instruments through net investment income in the summary of
operations. (B) Authority This rule is promulgated pursuant to the
authority vested in the superintendent under sections 3901.77 and 3903.72 to
3903.7211 of the Revised Code. (C) Definitions For the purposes of this rule, the following
definitions shall apply: (1) "Eligible
derivative instrument" means: (a) A call or put option derivative instrument that is
purchased to hedge the growth in interest credited to an indexed product as a
direct result of changes in the related external index or external
indices; (b) A call or put option derivative instrument that is
written to offset all or a portion of a call or put option derivative
instrument that meets the criteria set forth in paragraph (C)(1)(a) of this
rule; or (c) Other derivative instruments, such as index futures,
swaps and "swaptions," that may be used to hedge the growth in
interest credited to indexed products as a direct result of changes in the
related external index or external indices. (2) "External
index" means an index, a combination of indices, a combination of indices
and other financial instruments, or an exchange traded fund that is published
or disseminated by a source external to the insurance company and its
affiliates. (3) "Indexed annuity
products" means fixed indexed or index-linked variable annuity contracts
that include interest crediting provisions under which interest (which may be
subject to caps, participation rates, spreads, floors, terms or similar
limitations) is credited based upon the performance of one or more external
indices. (4) "Indexed life
products" means fixed indexed or index-linked variable life insurance
policies that include interest crediting provisions under which interest (which
may be subject to caps, participation rates, spreads, floors, buffers, terms or
similar limitations) is credited based upon the performance of one or more
external indices. (5) "Indexed
products" means indexed annuity products and indexed life
products. (6) "Interest
crediting period" means the period of time over which the performance of
an external index or external indices is measured for purposes of determining
the amount of interest credited under an indexed product. (D) Derivative accounting Insurance companies may elect to account for
eligible derivative instruments at amortized cost with the ability to record
settlement gains or losses through net investment income, if the insurance
company can demonstrate that such eligible derivative instruments meet all of
the following criteria for an economic hedge: (1) At inception of the
hedge, or as of the date that an insurance company elects to use the accounting
practices prescribed by this rule if later, there must be formal documentation
of the economic hedging relationship and the insurance company's risk
management objective and strategy for undertaking the economic hedge, including
identification of the specific eligible derivative instruments purchased to
hedge indexed products, the nature of the particular risk being hedged, and how
the eligible derivative instruments' effectiveness will be assessed,
retrospectively and prospectively, on a qualitative basis. (2) At inception of the
hedge, or as of the date that an insurance company elects to use the accounting
practices prescribed by this rule if later, and at the end of each quarterly
reporting period thereafter, the insurance company must maintain documentation
that the economic hedge is expected to be and continues to be highly effective
as defined by the criteria in paragraph (D)(1) of this rule in achieving
offsetting changes in fair value attributable to the hedged risk during the
period that the economic hedge is designated. (3) Amortized cost will
be based on the value at purchase for eligible derivative instruments defined
in paragraphs (C)(1)(a) and (C)(1)(b) of this rule. For eligible derivative
instruments defined in paragraph (C)(1)(c) of this rule, amortized cost will be
established at the beginning of a policy's crediting term based upon the
company's best estimate of the expected cost of the strategy using
well-established financial market mathematical models, formulae, or equations
that use assumptions that maximize the use of verifiable inputs. Deviations
from this estimate or other breakage on dynamic trading strategies will be
recognized immediately. (4) All income associated
with eligible derivative instruments shall be recorded in the summary of
operations, and shall be consistent with how the changes in indexed products
are recorded. (E) Indexed annuity products reserve
calculation methodology Insurance companies account for indexed annuity
product reserves in accordance with sections 3903.72 to 3903.7211 of the
Revised Code, and with the applicable actuarial guidelines and statutory
accounting principles. Based on the current guidelines, this rule provides
insurance companies with the ability to make the following adjustment, on a
policy level, to their indexed annuity product reserves for any index crediting
period that the policy is hedged by eligible derivative instruments that are
accounted for in accordance with paragraph (D) of this rule: (1) If an insurance
company determines indexed annuity product reserves based on "Actuarial
Guideline XXXV," the insurance company may assume the market value of the
eligible derivative instruments associated with the current interest crediting
period is zero, regardless of the observable market for such eligible
derivative instruments. Cash surrender values used to determine the reserves
shall be calculated consistently. (2) At the conclusion of
each interest crediting period, interest credited to an indexed annuity product
shall be reflected in the reserves and cash surrender value as realized, based
on the actual performance of the relevant external index. (F) Indexed life product reserve
calculation methodology Insurance companies account for indexed life
product reserves in accordance with the applicable actuarial guidelines and
statutory accounting principles. This rule does not provide for any adjustment
to the reserve calculation methodology for indexed life products. (G) Other requirements (1) Indexed annuity
products. The alternative accounting practices prescribed by this rule must be
applied during an index crediting period to both the eligible derivative
instruments used to hedge indexed annuity products and the related indexed
annuity product reserves. (2) Indexed life
products. The alternative accounting practices prescribed by this rule must be
applied only to the eligible derivative instruments used to hedge indexed life
products. This rule shall not impact the calculation of indexed life product
reserves. (3) If an insurance
company elects to use the alternative accounting practices prescribed by this
rule, it shall report quarterly to the superintendent, for analysis
purposes: (a) The market value of its eligible derivative instruments
and what the related actuarial reserves would be using market value of such
eligible derivative instruments, and the documentation the economic hedge is
and remains highly effective required by paragraph (D)(2) of this
rule. (b) For hedging activity that uses the dynamic hedging
strategy, the company shall report: (i) The estimate of
amortized cost, including the assumptions used in financial market models;
and (ii) The amount of
deviation from the estimate of amortized cost recognized during the period
reported. (4) Application of this
rule is not mandatory. An insurance company that elects to use the alternative
accounting practices prescribed by this rule may not elect to change its
accounting practices back to those that would apply in the absence of this rule
without the prior approval of the superintendent. (H) Severability If any paragraph, term or provision of this rule
is adjudged invalid for any reason, the judgment shall not affect, impair or
invalidate any other paragraph, term or provision of this rule, but the
remaining paragraphs, terms and provisions shall be and continue in full force
and effect.
Last updated April 15, 2021 at 9:04 AM
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