Chapter 3901. SUPERINTENDENT OF INSURANCE
There is hereby created a department of insurance which shall
have all powers and perform all duties formerly vested in and imposed upon the
department of commerce and the superintendent of insurance.
In enacting sections
121.02,
121.03,
121.04,
121.05,
121.08,
121.081,
121.082, 3901.01,
3901.011,
3901.02,
3901.03,
3901.04,
3901.05, and
3901.051 of the Revised Code, it
is the intent of the general assembly not to change the law as expressed by
Title 39 of the Revised Code prior to September 9, 1957, except insofar as
necessary to create a separate department of state government, known as the
department of insurance, and to vest in it all the powers and impose upon it
all the duties formerly vested in and imposed upon the department of commerce
respecting the superintendent of insurance and any officers, deputies, or
employees of the division of insurance, and except as otherwise expressly
provided by such amendments to former law as are specifically adopted in such
sections. All rules, regulations, and orders promulgated or issued by the
superintendent of insurance prior to September 9, 1957 are continued and
retained in full force and effect until amended, repealed, or revoked by the
superintendent of insurance.
Effective Date:
01-10-1961 .
The superintendent of insurance shall be the chief executive
officer and director of the department of insurance and shall have all the
powers and perform all the duties vested in and imposed upon the department of
insurance. The superintendent of insurance shall see that the laws relating to
insurance are executed and enforced. When a violation of a law relating to
insurance is reported to him, he shall take the testimony under oath of all
persons supposed to have knowledge of such violations, and cause such testimony
to be reduced to writing. If the superintendent decides that there is
sufficient evidence, he shall cause the person suspected of such violation to
be arrested and charged with such offense, and he shall furnish the proper
prosecuting attorney with all the information obtained by such superintendent,
the names of witnesses, and a copy of all material testimony taken in the case.
Effective Date:
09-09-1957 .
The superintendent of insurance may appoint such employees as
the prompt dispatch of business requires, including skilled and competent
persons to examine and report on the business and affairs of insurance
companies.
The superintendent may hire an administrator of financial
regulation services as an employee in the unclassified civil service. The
superintendent shall fix the compensation of the administrator of financial
regulation services.
The superintendent may hire actuaries as employees in the
unclassified civil service. The superintendent shall fix the compensation of
these actuaries, who shall be fellows of either the casualty actuarial society
or the society of actuaries.
All persons now employed in the division of insurance in the
classified civil service are transferred to the department of insurance in
their respective classifications subject to reassignment as the superintendent
of insurance may determine to be in the interest of efficient administration.
Effective Date:
09-29-1999 .
| (A) |
Three-fourths of all appointment and other fees
collected under
division (B) of section
3905.20 of the Revised Code shall
be paid into the state treasury to the credit of the department of insurance
operating fund, which is hereby created. The remaining one-fourth shall be
credited to the general revenue fund. Other revenues collected by the
superintendent of insurance, such as registration fees for sponsored seminars
or conferences and grants from private entities, shall be paid into the state
treasury to the credit of the department of insurance operating fund.
|
| (B) |
Seven-tenths of all fees collected under divisions
(A)(2), (A)(3), and (A)(6) of section
3905.40 of the Revised Code shall
be paid into the state treasury to the credit of the department of insurance
operating fund. The remaining three-tenths shall be credited to the general
revenue fund. |
| (C) |
All operating expenses of the department of
insurance except those expenses defined under section
3901.07 of the Revised Code shall
be paid from the department of insurance operating fund. |
Amended by
128th General AssemblyFile No.18, HB 300,
§1, eff.
5/26/2010.
Effective Date:
09-01-2002; 06-30-2005
The superintendent of insurance shall appoint a warden who
shall investigate all reported violations of law relating to insurance, and
perform such other duties in the administration of laws relating to insurance
as the superintendent may direct.
The office of the warden is hereby designated a criminal
justice agency in investigating reported violations of law relating to
insurance, and as such is authorized by this state to apply for access to the
computerized databases administered by the national crime information center or
the law enforcement automated data system in Ohio, and to other computerized
databases administered for the purpose of making criminal justice information
accessible to state criminal justice agencies.
Effective Date:
03-17-1998 .
| (A) |
As used in
this section:
| (1) |
"Laws of this state
relating to insurance" include but are not limited to Chapter 1751.
notwithstanding section
1751.08, Chapter 1753., Title
XXXIX, sections
5725.18 to
5725.25, and Chapter 5729. of the
Revised Code. Sections
4717.31,
4717.33,
4717.34,
4717.35, and
4717.37 of the Revised Code are
"laws of this state relating to insurance" to the extent those sections apply
to insurance companies or insurance agents. |
| (2) |
"Person" has the meaning defined in
division (A) of section
3901.19 of the Revised Code.
|
|
| (B) |
Whenever it appears
to the superintendent of insurance, from the superintendent's files, upon
complaint or otherwise, that any person has engaged in, is engaged in, or is
about to engage in any act or practice declared to be illegal or prohibited by
the laws of this state relating to insurance, or defined as unfair or deceptive
by such laws, or when the superintendent believes it to be in the best interest
of the public and necessary for the protection of the people in this state, the
superintendent or anyone designated by the superintendent under the
superintendent's official seal may do any one or more of the following:
| (1) |
Require any person to file with the
superintendent, on a form that is appropriate for review by the superintendent,
an original or additional statement or report in writing, under oath or
otherwise, as to any facts or circumstances concerning the person's conduct of
the business of insurance within this state and as to any other information
that the superintendent considers to be material or relevant to such business;
|
| (2) |
Administer oaths, summon and
compel by order or subpoena the attendance of witnesses to testify in relation
to any matter which, by the laws of this state relating to insurance, is the
subject of inquiry and investigation, and require the production of any book,
paper, or document pertaining to such matter. A subpoena, notice, or order
under this section may be served by certified mail, return receipt requested.
If the subpoena, notice, or order is returned because of inability to deliver,
or if no return is received within thirty days of the date of mailing, the
subpoena, notice, or order may be served by ordinary mail. If no return of
ordinary mail is received within thirty days after the date of mailing, service
shall be deemed to have been made. If the subpoena, notice, or order is
returned because of inability to deliver, the superintendent may designate a
person or persons to effect either personal or residence service upon the
witness. Service of any subpoena, notice, or order and return may also be made
in any manner authorized under the Rules of Civil Procedure. Such service shall
be made by an employee of the department designated by the superintendent, a
sheriff, a deputy sheriff, an attorney, or any person authorized by the Rules
of Civil Procedure to serve process. In the case of disobedience of any notice, order, or subpoena
served on a person or the refusal of a witness to testify to a matter regarding
which the person may lawfully be interrogated, the court of common pleas of the
county where venue is appropriate, on application by the superintendent, may
compel obedience by attachment proceedings for contempt, as in the case of
disobedience of the requirements of a subpoena issued from such court, or a
refusal to testify therein. Witnesses shall receive the fees and mileage
allowed by section
119.094 of the Revised Code. All
such fees, upon the presentation of proper vouchers approved by the
superintendent, shall be paid out of the appropriation for the contingent fund
of the department of insurance. The fees and mileage of witnesses not summoned
by the superintendent or the superintendent's designee shall not be paid by the
state.
|
| (3) |
In a case in
which there is no administrative procedure available to the superintendent to
resolve a matter at issue, request the attorney general to commence an action
for a declaratory judgment under Chapter 2721. of the Revised Code with respect
to the matter. |
| (4) |
Initiate
criminal proceedings by presenting evidence of the commission of any criminal
offense established under the laws of this state relating to insurance to the
prosecuting attorney of any county in which the offense may be prosecuted. At
the request of the prosecuting attorney, the attorney general may assist in the
prosecution of the violation with all the rights, privileges, and powers
conferred by law on prosecuting attorneys including, but not limited to, the
power to appear before grand juries and to interrogate witnesses before grand
juries. |
|
Effective Date:
10-01-1998; 2008
HB525 07-01-2009;
2008 SB196 07-06-2009
.
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. Title
XXXIX [39] of the Revised Code, subject to Chapter 119. of the Revised Code.
Effective Date:
10-01-1998 .
The superintendent of insurance may adopt rules in accordance
with Chapter 119. of the Revised Code for the purpose of implementing Amended
Substitute House Bill 478 of the 119th General Assembly, including rules that
establish fees for any service or transaction that is required by that act. The
rules shall specify each such service or transaction and the amount of the fee
that is so charged. Any fee collected pursuant to those rules shall be paid
into the state treasury to the credit of the department of insurance operating
fund.
Effective Date:
01-14-1993 .
The superintendent of
insurance may adopt rules in accordance with Chapter 119. of the Revised Code
to establish reasonable fees for any service or transaction performed by the
department of insurance pursuant to section 1751.03, 3901.321, 3901.341,
3907.12,
3911.011, 3913.40, 3915.14, 3917.06, 3918.07, 3923.02, 3935.04, 3937.03, or
3953.28 of the Revised Code or any provision in sections 3913.01 to 3913.23 or
in Chapter 3905. of the Revised Code, if no fee is otherwise provided under
Title XVII or XXXIX of the Revised Code for such service or transaction. Any
fee collected pursuant to those rules shall be paid into the state treasury to
the credit of the department of insurance operating fund.
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 08-06-2004
.
The superintendent of insurance may adopt rules in accordance
with Chapter 119. of the Revised Code that the superintendent considers
necessary and advisable for the purpose of implementing the "Health Insurance
Portability and Accountability Act of 1996,"
Pub. L. No. 104-191 , 110 Stat. 1955,
42 U.S.C.A. 300gg, as amended, and any regulation adopted
thereunder.
Effective Date:
06-30-1997 .
| (A) |
The
superintendent of insurance may receive documents and information, including
otherwise confidential or privileged documents and information, from local,
state, federal, and international regulatory and law enforcement agencies, from
local, state, and federal prosecutors, and from the national association of
insurance commissioners and its affiliates and subsidiaries, provided that the
superintendent maintains as confidential or privileged any document or
information received with notice or the understanding that the document or
information is confidential or privileged under the laws of the jurisdiction
that is the source of the document or information. |
| (B) |
The
superintendent may also receive documents and information, including otherwise
confidential or privileged documents and information, from the chief deputy
rehabilitator, the chief deputy liquidator, other deputy rehabilitators and
liquidators, and from any other person employed by, or acting on behalf of, the
superintendent pursuant to Chapter 3901. or 3903. of the Revised Code, provided
that the superintendent maintains as confidential or privileged any document or
information received with the notice or understanding that the document or
information is confidential or privileged, except that the superintendent may
share and disclose such a document or information when authorized by other
sections of the Revised Code. |
| (C) |
The
superintendent has the authority to maintain as confidential or privileged the
documents and information received pursuant to this section. |
| (D) |
The
superintendent's authority to receive documents and information under this
section, from the persons and subject to the conditions listed in this section,
is not limited in any way by section
1751.19,
3901.36,
3901.44,
3901.48,
3901.70,
3903.11,
3903.722,
3903.7211,
3903.88,
3905.50,
3922.21, or
3999.36
of the Revised Code. |
Amended by
133rd General Assembly File No. TBD, HB 339, §1,
eff. 1/1/2021.
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Amended by
129th General AssemblyFile No.48, HB 218,
§1, eff.
12/26/2011.
Effective Date: 06-18-2002
.
In the event of a vacancy in the office of the superintendent
of insurance, or in the absence or disability of that officer, or when so
directed by the superintendent, the deputy superintendent of insurance shall
perform all the duties of the superintendent. In the absence of the
superintendent and the deputy superintendent, and when so directed by the
superintendent, either assistant superintendent shall perform all the duties of
the superintendent. The deputy superintendent, or either assistant
superintendent, may serve upon any board or commission of which the
superintendent is a member.
Effective Date:
09-09-1957 .
The assistant superintendents shall perform such duties of the
superintendent and such other duties as the superintendent shall direct.
Effective Date:
09-09-1957 .
The superintendent of insurance shall apply to the
United States secretary of health and human services and the United States
secretary of the treasury for an innovative waiver regarding health insurance
coverage in this state as authorized by section 1332 of the "Patient Protection
and Affordable Care Act," 42 U.S.C. 18052. The superintendent shall
include in the application a request for waivers of the employer and individual
mandates in sections 4980H and 5000A of the "Internal Revenue Code of 1986,"
26 U.S.C. 4980H and
5000A. The application shall
provide for the establishment of a system that provides access to affordable
health insurance coverage for the residents of this state.
Added by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
A certificate, assignment, or conveyance executed in pursuance
of law by the superintendent of insurance with the seal of his office affixed
thereto shall be received as evidence and may be recorded in the same manner
and with like effect as a deed duly acknowledged by an officer authorized by
law. In all cases copies of papers in the office of the superintendent,
certified by him under the seal of his office, are equal to the original as
evidence.
Effective Date:
10-01-1953 .
| (A) |
As used in
this section, "insurer" means any person doing or authorized to do any
insurance business in this state. |
| (B) |
| (1) |
Before
issuing any license to do the business of insurance in this state, the
superintendent of insurance, or a person appointed by him, may examine the
financial affairs of any insurer. |
| (2) |
The superintendent, or any person appointed by
him, may examine, as often as he considers it desirable, the affairs of any
insurer and of any person as to any matter relevant to the financial affairs of
the insurer or to the examination. |
| (3) |
The superintendent, or any person appointed by
him, shall examine each domestic insurer at least once every three years as to
its condition, fulfillment of its contractual obligations, and compliance with
applicable laws, provided that he may defer making the examination for a longer
period not to exceed five years. |
|
| (C) |
In scheduling and determining the nature, scope,
and frequency of any examination authorized or required by division (B) of this
section, the superintendent shall consider such matters as the results of
financial statement analyses and ratios, changes in management or ownership,
actuarial opinions, reports of independent certified public accountants, and
any other criteria he considers appropriate. |
| (D) |
The superintendent, in lieu of making any
examination authorized or required by division (B) of this section, may accept
the report of an examination of a foreign or alien insurer made and certified
by the superintendent of insurance or other insurance supervisory official of
the state or government of domicile or state of entry. The examination of an
alien insurer shall be limited to its United States business except as
otherwise required by the superintendent. |
| (E) |
Whenever the superintendent determines to examine
the affairs of any insurer pursuant to any examination authorized or required
by division (B) of this section, he shall appoint as examiners one or more
competent persons not employed by or interested in any insurer except as a
policyholder. The superintendent shall instruct the examiners as to the scope
of the examination. Each examiner appointed under this division shall have
convenient access at all reasonable hours to the books, records, files,
securities, and other documents of the insurer, its managers, agents, or other
persons that are relevant to the examination. The examiner may administer oaths
and examine any person under oath as to any matter relevant to the affairs of
the insurer or the examination.
|
| (F) |
If the superintendent finds the accounts of an
insurer being examined pursuant to any examination authorized or required by
division (B) of this section to be inadequate or improperly kept or posted and
if the insurer has been afforded a reasonable opportunity to correct the
accounts, the superintendent may employ or require the insurer to employ
experts to rewrite, post, or balance the accounts. The employment of experts
under this division shall be at the expense of the insurer. |
| (G) |
In connection with any examination
authorized or required by division (B) of this section, the superintendent may
appoint one or more competent persons to appraise the real property of the
insurer or any real property on which the insurer holds security. |
| (H) |
The examiner in charge of any
examination authorized or required by division (B) of this section shall make a
true report of the examination, verified under oath, that shall comprise only
facts appearing upon the books, records, or other documents of the insurer or
its agents or other persons examined, or as ascertained from the sworn
testimony of its officers or agents or other persons examined concerning its
affairs, and such conclusions and recommendations as may be reasonably
warranted from those facts. The reports so verified shall be prima-facie
evidence in any action or proceeding for the rehabilitation or liquidation of
the insurer brought in the name of the state against the insurer or its
officers or agents. |
| (I) |
The
examined insurer, within thirty days after the postmark on the envelope in
which the report was mailed, may file with the superintendent written
objections to the report. The objections shall be attached to and made a part
of the report, which then shall be placed in the files of the department of
insurance as a public record. |
| (J) |
| (1) |
The officers, directors, managers,
employees, and agents of an insurer shall facilitate in every way any
examination authorized or required by division (B) of this section and, to the
extent of their authority, aid the examiners and persons appointed or employed
pursuant to divisions (E), (F), and (G) of this section in conducting the
examination. |
| (2) |
No officer,
director, manager, employee, or agent of an insurer shall do any of the
following:
| (a) |
Fail to comply with division
(J)(1) of this section; |
| (b) |
Refuse,
without just cause, to be examined under oath; |
| (c) |
Knowingly obstruct or interfere with an
examiner or any person appointed or employed pursuant to division (E), (F), or
(G) of this section in the exercise of his authority under this section.
|
|
| (3) |
No insurer shall
refuse to submit to an examination authorized or required by division (B) of
this section. The superintendent, in accordance with Chapter 119. of the
Revised Code, may suspend or revoke or refuse to issue or renew the license of
any insurer that violates division (J)(3) of this section. |
|
| (K) |
Personnel conducting an
examination shall be compensated for each day or portion thereof worked at the
rates provided in the examiners' handbook published by the national association
of insurance commissioners or the rates applicable to such personnel under
section 124.15 or
124.152 of the Revised Code,
whichever are higher. Such personnel shall also be reimbursed for their travel
and living expenses at rates not to exceed the rates provided in the examiners'
handbook published by the association. Personnel who are appointed by the
superintendent, but are not employees of the department of insurance, shall be
compensated for their work and travel and living expenses at reasonable and
customary rates. |
| (L) |
If an
examination is made of any insurer, the expenses thereof shall be paid by the
insurer. The superintendent shall provide each insurer with an itemized
statement of the expenses incurred in the performance of the examination
functions authorized or required by this section. Upon receipt of the
superintendent's statement, the insurer shall remit the amount thereof to the
superintendent who shall remit to the treasurer of state pursuant to section
3901.071 of the Revised Code for
deposit in the superintendent's examination fund.
|
| (M) |
As used in this section, "expenses" means:
| (1) |
The entire compensation for each day or
portion thereof worked by all personnel, including those who are not employees
of the department of insurance, in:
| (a) |
The
conduct of such examination calculated at the rates provided in the examiners'
handbook published by the national association of insurance commissioners;
|
| (b) |
The review and analysis of the
annual and any interim financial statements of insurers licensed in this state;
|
| (c) |
The ongoing evaluation and
monitoring of the financial affairs of licensed insurers; |
| (d) |
The preparation of the premium or
franchise tax liability of licensed insurers; |
| (e) |
The review and evaluation of foreign and
alien insurers seeking a license in this state; |
| (f) |
A portion of the training and continuing
education costs of examiners. |
|
| (2) |
Travel and living expenses of all
personnel, including those who are not employees of the department, directly
engaged in the conduct of such examination calculated at rates not to exceed
the rates provided in the examiners' handbook published by the association;
|
| (3) |
All other incidental expenses
incurred by or on behalf of such personnel in the conduct of such examination;
|
| (4) |
An allocated share of all
expenses not paid as described in division (M)(1), (2), or (3) of this section
that are necessarily incurred in carrying out the duties of the superintendent
under this section, including the expenses of direct overhead and support staff
for the examiners and persons appointed or employed pursuant to divisions (E),
(F), and (G) of this section. |
|
Effective Date:
08-08-1991 .
All moneys collected by the superintendent of insurance for
expenses incurred by the superintendent in conducting examinations pursuant to
the Revised Code of the financial affairs of any insurance company doing
business in this state, for which the insurance company examined is required to
pay the costs, shall be paid to the superintendent. The superintendent shall
deposit the money in the state treasury to the credit of the superintendent's
examination fund, which is hereby established. Any funds expended or obligated
therefrom by the superintendent shall be expended or obligated solely for
defrayment of the costs of examinations of the financial affairs of insurance
companies made by the superintendent pursuant to the Revised Code. For purposes
of this section, "insurance company" means any domestic or foreign stock
company, risk retention group, mutual company, mutual protective association,
fraternal benefit society, reciprocal or inter-insurance exchange, and health
insuring corporation, regardless of the type of coverage written, benefits
provided, or guarantees made by each.
Effective Date:
06-04-1997 .
| (A) |
| (1) |
Sections 3901.072 to
3901.078 of the Revised Code shall be known as the corporate governance annual
disclosure act. |
| (2) |
Sections 3901.072 to 3901.078 of the Revised Code
shall apply to all insurers domiciled in this state. |
| (3) |
Nothing in sections 3901.072 to 3901.078 of the
Revised Code shall be construed to prescribe or impose corporate governance
standards and internal procedures beyond those required under the corporate
laws of this state. Notwithstanding the foregoing, nothing in those sections
shall be construed to limit the superintendent's authority, or the rights or
obligations of third parties, under section
3901.07 of the Revised
Code. |
|
| (B) |
As used in this section and sections 3901.073 to 3
901.078 of the Revised Code:
| (1) |
"Corporate governance annual disclosure" or "CGAD"
means a confidential report filed by an insurer or insurance group in
accordance with the requirements of sections 3901.072 to 3901.078 of the
Revised Code. |
| (2) |
"Insurance group" means
those insurers and affiliates included within an insurance holding company
system as defined in section
3901.32 of the Revised
Code. |
| (3) |
"Insurer" has the same
meaning as in section
3901.32 of the Revised
Code. |
| (4) |
"NAIC" means the national
association of insurance commissioners. |
| (5) |
"Superintendent" means the superintendent of
insurance. |
|
Added by
131st General Assembly File No. TBD, SB 273, §1,
eff. 1/1/2017.
| (A) |
| (1) |
| (a) |
Not later than June 1,
2017, an insurer domiciled in this state, or the insurance group of which the
insurer is a member, that, as of December 31, 2015, has an annual, direct
written and unaffiliated assumed premium totaling more than five billion
dollars, shall submit to the superintendent a corporate governance annual
disclosure that contains the information described in section 3901.074 of the
Revised Code. |
| (b) |
Not later than June 1 ,
2018, and on or before the first day of June each year thereafter, an insurer
domiciled in this state, or the insurance group to which the insurer is a
member, shall submit to the superintendent a corporate governance annual
disclosure that contains the information described in section 3901.074 of the
Revised Code. |
|
| (2) |
Notwithstanding any request from the superintendent,
if the insurer is a member of an insurance group, the insurer shall submit the
report required by division (A)(1) of this section if the superintendent is the
lead state commissioner of the insurance group as determined by the procedures
outlined within the most recent financial analysis handbook adopted by the
NAIC. The review of the CGAD and any additional requests for information shall
be made by the lead state as determined by the procedures within the most
recent financial analysis handbook adopted by the NAIC. |
|
| (B) |
An insurer not required
to submit a CGAD under division (A) of this section shall do so upon request of
the superintendent. |
| (C) |
The CGAD shall include a signature of the insurer or
insurance group's chief executive officer or corporate secretary attesting to
the best of that individual's belief and knowledge that the insurer has
implemented the corporate governance practices and that a copy of the
disclosure has been provided to the insurer's board of directors or the
appropriate committee hereof. |
| (D) |
| (1) |
For purposes of completing the CGAD, the insurer or
insurance group may provide information regarding corporate governance at one
or all of the following levels depending on how the insurer or insurance group
has structured its system of corporate governance:
| (a) |
The ultimate controlling parent level; |
| (b) |
An intermediate holding
company level; |
| (c) |
The individual legal
entity level. |
|
| (2) |
The insurer or insurance group is encouraged to make
the CGAD disclosures at one of the following levels:
| (a) |
At the level at which the insurer's or insurance
group's risk appetite is determined ; |
| (b) |
At the level at which the insurer's earnings, capital,
liquidity, operations, and reputation are overseen collectively and at which
the supervision of those factors is coordinated and exercised ; |
| (c) |
At the level at which
legal liability for failure of general corporate governance duties would be
placed. |
|
| (3) |
If the insurer or insurance group determines the level
of reporting based on the criteria listed in division (D)(2) of this section,
it shall indicate which of the three criteria was used to determine the level
of reporting and explain any subsequent changes in the level of
reporting. |
|
| (E) |
If an insurer provides information substantially
similar to the information required under sections 3901.072 to 3 901.078 of the
Revised Code in other documents provided to the superintendent, including proxy
statements filed in conjunction with insurance holding company registration or
other state or federal filings provided to the department, the insurer shall
not be required to duplicate the information and may comply with division (A)
of this section by referencing within the CGAD the relevant document. |
Added by
131st General Assembly File No. TBD, SB 273, §1,
eff. 1/1/2017.
| (A) |
| (1) |
An insurer or insurance
group shall have discretion regarding the format of its corporate governance
annual disclosure. |
| (2) |
The CGAD shall be prepared consistent with the rules
adopted by the superintendent pursuant to section 3901.077 of the Revised Code
regarding the required content of the CGAD and shall contain the material
information necessary for the superintendent to gain an understanding of the
insurer's or group's corporate governance structure, policies, and
practices. |
| (3) |
All documentation and
supporting information shall be maintained and made available for examination
upon request of the superintendent. |
|
| (B) |
The superintendent may request additional information
the superintendent considers material and necessary to provide a clear
understanding of the insurer's or insurance group's corporate governance
policies and the reporting or information system or controls implementing those
policies. |
Added by
131st General Assembly File No. TBD, SB 273, §1,
eff. 1/1/2017.
| (A) |
Documents, materials, or
other information, including the corporate governance annual disclosure, in the
possession or control of the department of insurance that are obtained by,
created by, or disclosed to the superintendent or any other person under
sections 3901.072 to 3901.078 of the Revised Code are recognized by this state
as being proprietary and to contain trade secrets. |
| (B) |
The documents, materials, or other information
described in division (A) of this section shall be confidential by law and
privileged and shall not be admissible into evidence in any private civil
action or subject to section
149.43 of the Revised Code,
subpoena, or discovery. |
| (C) |
| (1) |
Notwithstanding division (B) of this section, the
superintendent may use the documents, materials, or other information described
in division (A) of this section in furtherance of any regulatory or legal
action brought as part of the superintendent's official duties. |
| (2) |
The superintendent shall
not otherwise make the documents, materials, or other information public
without the prior written consent of the insurer. |
| (3) |
Nothing in division (B) or (C) of this section shall
be construed to require the written consent of the insurer before the
superintendent shares or receives confidential documents, materials, or other
CGAD-related information pursuant to division (E) of this section to assist in
the performance of the superintendent's regulatory duties. |
|
| (D) |
Neither the
superintendent nor any person who receives documents, materials, or other CGAD
- related information, through examination or otherwise, while acting under the
authority of the superintendent or with whom such documents, materials, or
other information are shared pursuant to sections 3901. 0 72 to 3 901.078 of
the Revised Code shall be permitted or required to testify in any private civil
action concerning any confidential documents, materials, or information
described in division (A) of this section. |
| (E) |
| (1) |
In order to assist in the performance of the
superintendent's regulatory duties, the superintendent may do either of the
following:
| (a) |
Upon request, share
documents, materials, or other CGAD-related information, including confidential
and privileged documents, materials, or information subject to division (A) of
this section, and proprietary and trade secret documents, with other state,
federal, and international financial regulatory agencies, members of any
supervisory college as described in section
3901.351 of the Revised Code,
the NAIC, or any third-party consultant pursuant to section 3901.076 of the
Revised Code; |
| (b) |
Receive documents,
materials, or other CGAD-related information, including confidential and
privileged documents, materials, or information subject to division (A) of this
section, and proprietary and trade secret documents, from regulatory officials
or other foreign or domestic jurisdictions, including members of any
supervisory college as described in section
3901.351 of the Revised Code,
and from the NAIC. |
|
| (2) |
The recipient of any information pursuant to division
(E)(1)(a) of this section shall agree in writing to maintain the
confidentiality and privileged status of the documents, materials, or other
information and verify in writing their legal authority to maintain
confidentiality. If the superintendent receives any information pursuant to
division (E) (1)(b) of this section, the superintendent shall maintain as
confidential or privileged any documents, materials, or information received
with notice or the understanding that it is confidential or privileged under
the laws of the jurisdiction that is the source of the document, material, or
information. |
|
| (F) |
The sharing of information, materials, and documents
by the superintendent pursuant to sections 3901.072 to 3901.078 of the Revised
Code shall not constitute a delegation of regulatory or rule-making authority,
and the superintendent is solely responsible for the administration, execution,
and enforcement of sections 3901.072 to 3901.078 of the Revised Code. |
| (G) |
No waiver of any
applicable privilege or claim of confidentiality in the document, proprietary
and trade-secret materials, or other CGAD-related information shall occur as a
result of disclosure of such CGAD-related information, materials, or documents
to the superintendent as a result of sharing authorized in sections 3901.072 to
3901.078 of the Revised Code. |
Added by
131st General Assembly File No. TBD, SB 273, §1,
eff. 1/1/2017.
| (A) |
The superintendent may
retain a third-party consultant, including attorneys, actuaries, accountants,
and other experts not otherwise part of the superintendent's staff, as is
reasonably necessary to assist the superintendent in reviewing a corporate
governance annual disclosure and related information or an insurer's compliance
with sections 3901.072 to 3901.078 of the Revised Code. The superintendent
shall retain a third-party consultant under this division at the expense of the
applicable insurer. |
| (B) |
Each third-party consultant retained under division
(A) of this section shall do all of the following :
| (1) |
Serve under the direction and control of the
superintendent in a purely advisory capacity; |
| (2) |
Comply with the confidentiality requirements
applicable to the superintendent under sections 3901.072 to 3 901.078 of the
Revised Code; |
| (3) |
Verify to the
superintendent, with notice to the insurer, that the consultant is free of a
conflict of interest and has internal procedures in place to monitor compliance
with a conflict and to comply with the confidentiality requirements of sections
3901.072 to 3901.078 of the Revised Code. |
|
| (C) |
If the superintendent enters into a written agreement
with the NAIC, a third-party consultant, or both, regarding the sharing and use
of information provided pursuant to sections 3 901.072 to 3901.078 of the
Revised Code, the written agreement shall do all of the following:
| (1) |
Specify procedures and protocols for maintaining the
confidentiality and security of CGAD-related information shared with the NAIC
or a third-party consultant pursuant to sections 3 901.072 to 3901.078 of the
Revised Code, including procedures and protocols for sharing by the NAIC only
with other state regulators from states in which the insurance group has
domiciled insurers; |
| (2) |
Provide that the recipient of information agrees in
writing to maintain the confidentiality and privileged status of the
CGAD-related documents, materials, or other information obtained pursuant to
sections 3901.072 to 3901.078 of the Revised Code and has verified in writing
the legal authority to maintain confidentiality; |
| (3) |
Specify that ownership of information shared with the
NAIC or a third - party consultant pursuant to sections 3901.072 to 3901.078 of
the Revised Code remains with the department of insurance and the NAIC's or
third-party consultant's use of the information is subject to the direction of
the superintendent; |
| (4) |
Prohibit the NAIC or a third-party consultant from
storing the information obtained pursuant to sections 3901.072 to 3901.078 of
the Revised Code in a permanent database after the underlying analysis is
completed; |
| (5) |
Require the NAIC or a
third-party consultant to provide prompt notice to the superintendent and to
the insurer or insurance group regarding any request or subpoena for disclosure
or production of the insurer's CGAD-related information; |
| (6) |
Require the NAIC or a third-party consultant to
consent to intervention by an insurer in any judicial or administrative action
in which the NAIC or third-party consultant may be required to disclose
confidential information about the insurer that was obtained pursuant to
sections 3 901.072 to 3 901.078 of the Revised Code ; |
| (7) |
Require the insurer's written consent prior to making
public information that was obtained pursuant to sections 3901.072 to 3901.078
of the Revised Code. |
|
Added by
131st General Assembly File No. TBD, SB 273, §1,
eff. 1/1/2017.
The superintendent shall adopt rules in accordance with
Chapter 119. of the Revised Code as are reasonably necessary to implement
sections 3901.072 to 3901.078 of the Revised Code.
Added by
131st General Assembly File No. TBD, SB 273, §1,
eff. 1/1/2017.
| (A) |
If the superintendent
finds, after notice and an opportunity for a hearing conducted in accordance
with Chapter 119. of the Revised Code, that an insurer has failed to file a
corporate governance annual disclosure as required by division (A) of section
3901.073 of the Revised Code, the superintendent shall assess a civil penalty
against the insurer.
| (1) |
The amount of the civil
penalty imposed by division (A) of this section shall be one hundred dollars
for each day the CGAD is past due, provided that the total penalty shall not
exceed the sum of ten thousand dollars. |
| (2) |
All sums collected from such penalties shall be
deposited in the general revenue fund. |
|
| (B) |
The superintendent may reduce the amount of the civil
penalty if the insurer demonstrates to the superintendent that the imposition
of the penalty would constitute a financial hardship to the insurer. |
Added by
131st General Assembly File No. TBD, SB 273, §1,
eff. 1/1/2017.
The superintendent of insurance may make written requisitions
upon the officers or directors of any national bank, state bank, or state bank
and trust company of this state, and upon any clearing corporation, direct
participant, or member bank, as defined in section
3901.51 of the Revised Code,
domiciled or doing business in this state, for information as he requires
relating to the financial transactions of any of these institutions or entities
with any insurance company, fraternal beneficiary association, or assessment
association authorized to do business in this state.
Effective Date:
09-28-1990 .
Any officer or director of any national bank, state bank, or
state bank and trust company of this state, and any clearing corporation,
direct participant, or member bank, as defined in section
3901.51 of the Revised Code,
domiciled or doing business in this state, upon the receipt of the requisition
authorized by section
3901.08 of the Revised Code, or
within five days after the receipt of the requisition, shall furnish to the
superintendent of insurance in writing all the information called for in the
requisition and in the manner and form as directed in the requisition.
Effective Date:
09-28-1990 .
If it appears to the superintendent of insurance upon
satisfactory evidence that the assets of an insurance company, organized under
the laws of this state, after deducting therefrom all liabilities including
reinsurance, reserve, or unearned premium fund, computed according to the laws
of this state, are reduced below the capital required by law for a stock
company or the surplus required for any other company, he shall require such
company to restore such deficiency within a period designated by him of not
less than thirty days nor more than ninety days. He may prohibit such company
from issuing any new policies or transacting any new business until it has
furnished evidence satisfactory to him that such deficiency has been restored,
or until so authorized by a court in a proper proceeding therein. If the
superintendent prohibits such company from issuing any new policies or
transacting any new business, all licensed agents and solicitors of such
company shall be notified of such prohibition in such manner as the
superintendent shall direct. Thereafter, no such agent or solicitor shall
procure applications for insurance or issue policies for such company until
authorized by the superintendent or by a court.
Effective Date:
09-04-1970 .
Any domestic insurer and any foreign or alien insurer
authorized to do business in this state may retain, invest in, or acquire the
whole or any part of the capital stock of any other insurer, or have a common
management with any other insurer, provided such retention, investment,
acquisition, or common management is not inconsistent with any other law
relating to the investment of the funds of domestic insurers, and provided
further that by reason of such retention, investment, or acquisition of such
capital stock, or common management, the business of such insurers with the
public shall not be conducted in a manner which substantially lessens
competition generally in the business of insurance or creates a monopoly
therein.
Effective Date:
10-01-1953 .
Any person otherwise qualified may be a director of two or more
insurers which are competitors or which have a common management, but no such
interlocking directorate shall be used as a means of substantially lessening
competition generally in the business of insurance or of creating a monopoly
therein.
Effective Date:
10-01-1953 .
Whenever the superintendent of insurance has reason to believe
that there is a violation of section
3901.11 or
3901.12 of the Revised Code, he
shall serve upon the insurers and directors a notice of a hearing before the
superintendent to be held not less than thirty days after the service of such
notice, and requiring such insurers and directors to show cause why an order
should not be made by the superintendent directing such insurers and directors
to cease and desist from such violation. All such hearings shall be conducted
in accordance with sections
119.01 to
119.13, inclusive, of the Revised
Code.
If, upon such hearing, the superintendent finds that there has
been a violation of section
3901.11 or
3901.12 of the Revised Code, he
shall issue and cause to be served upon such insurers and directors an order
reciting the facts found by him, setting forth the respects in which there has
been a violation, and directing such insurers and directors to cease and desist
from such violation.
Any such order of the superintendent shall be subject to
judicial review in accordance with sections
119.01 to
119.13, inclusive, of the Revised
Code. A violation of any such order is, subject to said judicial review, deemed
a violation as contemplated by section
3901.16 or
3901.17 of the Revised Code.
Effective Date:
10-01-1953 .
The superintendent of insurance shall preserve a full record of
his proceedings, including a concise statement of the condition of each
insurance company or association authorized to transact business in this state.
Each year the superintendent shall report their general conduct and condition,
including the information contained in the statement required of them, arranged
in tabular form in two separate reports, one pertaining to life insurance
companies and the second to all other insurance companies.
Effective Date:
09-06-1965 .
The laws relating to the superintendent of insurance apply to
all persons, companies, and associations, whether incorporated or not, engaged
in the business of insurance.
Effective Date:
10-01-1953 .
Any association, company, or corporation, including a health
insuring corporation, which violates any law relating to the superintendent of
insurance, any provision of Chapter 1751. or 1753. of the Revised Code, or any
insurance law of this state, for the violation of which no forfeiture or
penalty is elsewhere provided in the Revised Code, shall forfeit and pay not
less than one thousand nor more than ten thousand dollars, to be recovered by
an action in the name of the state and on collection to be paid to the
superintendent, who shall pay such sum into the state treasury.
Effective Date:
10-01-1998 .
| (A) |
As used in this section:
| (1) |
"Captive insurer" has the same meaning
as
in section 3905.36 of the Revised Code. |
| (2) |
"Insurer" includes, but is not limited to, any person that is an affiliate of
or affiliated with the insurer, as defined in section 3901.32 of the Revised
Code, and any person that is a subsidiary of the insurer as defined in
section 3901.32 of the
Revised Code. |
| (3) |
"Laws of
this state relating to insurance" has the same
meaning as in section 3901.04 of the Revised Code. |
| (4) |
"Person" has the same meaning
as in section 3901.19 of the Revised Code. |
| (5) |
"Home state" has the same meaning as in section 3905.30 of the Revised
Code. |
|
| (B) |
Any of the following acts in this state, effected
by mail or otherwise, by any foreign or alien insurer not authorized to
transact business within this state, any nonresident person acting on behalf of
an insurer, or any nonresident insurance agent subjects the insurer, person, or
agent to the exercise of personal jurisdiction over the insurer, person, or
agent to the extent permitted by the constitutions of this state and of the
United States:
| (1) |
Issuing or
delivering contracts of insurance to residents of this state or to corporations
authorized to do business therein; |
| (2) |
Making or proposing to make any insurance contracts; |
| (3) |
Soliciting, taking, or receiving any application for insurance; |
| (4) |
Receiving or collecting any premium, commission, membership fee, assessment,
dues, or other consideration for any insurance contract or any part
thereof; |
| (5) |
Disseminating information as to coverage or rates, forwarding applications,
inspecting risks, fixing rates, investigating or adjusting claims or losses, or
transacting any matters subsequent to effecting a contract of insurance and
arising out of it; |
| (6) |
Doing any
kind of business recognized as constituting the doing of an insurance business
under Title XXXIX of the Revised Code or subject to regulation by the
superintendent of insurance under the laws of this state relating to insurance. Any such act shall be
considered to be the doing of an insurance business in this state by such
insurer, person, or agent and shall be its agreement that service of any lawful
subpoena, notice, order, or process is of the same legal force and validity as
personal service of the subpoena, notice, order, or process in this state upon
the insurer, person, or agent.
|
|
| (C) |
Service of process in judicial proceedings shall be as provided by the Rules of
Civil Procedure. Service in or out of this state of notice, orders, or
subpoenas in administrative proceedings before the superintendent shall be as
provided in section 3901.04 of the Revised Code. |
| (D) |
Service of any notice, order, subpoena, or process in any such action, suit, or
proceeding shall, in addition to the manner provided in division (C) of this
section, be valid if served upon any person within this state who, in this
state on behalf of such insurer, person, or agent is or has been:
| (1) |
Soliciting, procuring, effecting, or negotiating for insurance; |
| (2) |
Making, issuing, or delivering any contract of insurance; |
| (3) |
Collecting or receiving any premium, membership fees, assessment, dues, or
other consideration for insurance; |
| (4) |
Disseminating information as to coverage or rates, forwarding applications,
inspecting risks, fixing rates, investigating or adjusting claims or losses, or
transacting any matters subsequent to effecting a contract of insurance and
arising out of it. |
|
| (E) |
Nothing in this section shall limit or abridge the right to serve any subpoena,
order, process, notice, or demand upon any insurer, person, or agent in any
other manner permitted by law. |
| (F) |
Every person investigating or adjusting any loss or claim under a policy of
insurance not excepted under division (I) of this section and issued by any
such insurer and covering a subject of insurance that was resident, located, or
to be performed in this state at the time of issuance shall immediately report
the policy to the superintendent. |
| (G) |
If
this state is the home state of the insured, each such insurer that does any of
the acts set forth in division (B) of this section shall be subject to the
requirements of section 3905.36 of the Revised Code. |
| (H) |
No
contract of insurance effected in this state by mail or otherwise by any such
insurer is enforceable by the insurer. |
| (I) |
This section does not apply to:
| (1) |
Insurance
obtained pursuant to sections 3905.30 to 3905.36 of the Revised Code; |
| (2) |
The
transaction of reinsurance by insurers; |
| (3) |
Transactions in this state involving a policy of group life or group accident
and sickness insurance solicited, written, and delivered outside this
state; |
| (4) |
Transactions
involving contracts of insurance independently procured through negotiations
occurring entirely outside this state which are reported and the tax is paid in
accordance with section 3905.36 of the Revised Code; |
| (5) |
An
attorney at law acting on behalf of the attorney's clients in the adjustment of
claims or losses; |
| (6) |
Ocean marine
insurance; |
| (7) |
Transactions
involving policies issued by a captive insurer. |
|
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Amended by
129th General AssemblyFile No.5, HB 122,
§1, eff.
6/17/2011.
Effective Date:
06-30-1997; 06-30-2005
| (A) |
Before any
unauthorized foreign or alien insurer may enter an appearance in any court
action, suit, or proceeding or in any administrative proceeding before the
superintendent of insurance, such unauthorized insurer shall either:
| (1) |
Deposit with the clerk of the court in
which such action, suit, or proceeding is pending or with the superintendent if
such proceeding is before him, cash or securities or file with such clerk or
the superintendent a bond with good and sufficient sureties, to be approved by
the court or the superintendent, in an amount to be fixed by the court
sufficient to secure the payment of any final judgment which may be rendered in
any such court action, suit, or proceeding or by the superintendent sufficient
to satisfy any order issued by the superintendent; |
| (2) |
Procure a certificate of authority to
transact the business of insurance in this state. |
|
| (B) |
In any action, suit, or proceeding, in
which service is made in the manner provided in division (B) or (C) of section
3901.17 of the Revised Code the
court or, if the proceeding is before the superintendent of insurance, the
superintendent may order such postponement as may be necessary to afford the
unauthorized insurer reasonable opportunity to comply with the provisions of
division (A) of this section and to defend such action, suit, or proceeding.
|
| (C) |
Nothing in division (A) of
this section shall prevent an unauthorized foreign or alien insurer from filing
a motion to set aside service made in the manner provided in division (B) or
(C) of section
3901.17 of the Revised Code on the
ground either:
| (1) |
That such unauthorized
insurer has not done any of the acts enumerated in division (A) of section
3901.17 of the Revised Code;
|
| (2) |
That the person on whom service
was made pursuant to division (C) of section
3901.17 of the Revised Code was
not doing or had not done any of the acts enumerated in division (C) of section
3901.17 of the Revised Code.
|
|
| (D) |
The provisions of
this section do not apply to ocean marine insurance. |
Effective Date:
11-21-1967 .
As used in sections 3901.19 to
3901.26 of the Revised Code:
| (A) |
"Person" means any individual,
corporation, association, partnership, reciprocal exchange, inter-insurer,
fraternal benefit society, title guarantee and trust company, health insuring
corporation, and any other legal entity. |
| (B) |
"Residents" includes any individual, partnership,
or corporation. |
| (C) |
"Maternity
benefits" means those benefits calculated to indemnify the insured for hospital
and medical expenses fairly and reasonably associated with a pregnancy and
childbirth. |
| (D) |
"Insurance"
includes, but is not limited to, any policy or contract offered, issued, sold,
or marketed by an insurer, corporation, association, organization, or entity
regulated by the superintendent of insurance or doing business in this state.
Nothing in any other section of the Revised Code shall be construed to exclude
single premium deferred annuities from the regulation of the superintendent
under sections 3901.19 to
3901.26 of the Revised Code.
|
| (E) |
"Affiliate" means any company
that controls, is controlled by, or is under common control with, another
company. |
| (F) |
"Customer" means an
individual who purchases, applies to purchase, or is solicited to purchase
insurance products primarily for personal, family, or household purposes.
|
| (G) |
"Depository institution"
means a bank, savings bank, savings and loan association, or credit union that
is subject to regulation or supervision by the United States or any state.
"Depository institution" does not include an insurance company. |
| (H) |
"Insurance agent" or "agent" has the
same meaning as in section
3905.01 of the Revised Code.
|
| (I) |
"Insurer" has the same
meaning as in section
3901.32 of the Revised Code.
|
| (J) |
"Policy" or "certificate"
means a contract of insurance, indemnity, medical, health or hospital service,
suretyship, or annuity issued, proposed for issuance, or intended for issuance
by any insurer. |
Effective Date:
09-01-2002 .
No person shall engage in this state in any trade practice
which is defined in sections
3901.19 to
3901.23 of the Revised Code as, or
determined pursuant to those sections to be, an unfair or deceptive act or
practice in the business of insurance.
This section applies to any person, as defined in section
3901.19 of the Revised Code,
regardless of whether the person is licensed or required to be licensed by the
superintendent of insurance.
Effective Date:
01-05-1988 .
The following are hereby
defined as unfair and deceptive acts or practices in the business of
insurance:
| (A) |
Making,
issuing, circulating, or causing or permitting to be made, issued, or
circulated, or preparing with intent to so use, any estimate, illustration,
circular, or statement misrepresenting the terms of any policy issued or to be
issued or the benefits or advantages promised thereby or the dividends or share
of the surplus to be received thereon, or making any false or misleading
statements as to the dividends or share of surplus previously paid on similar
policies, or making any misleading representation or any misrepresentation as
to the financial condition of any insurer as shown by the last preceding
verified statement made by it to the insurance department of this state, or as
to the legal reserve system upon which any life insurer operates, or using any
name or title of any policy or class of policies misrepresenting the true
nature thereof, or making any misrepresentation or incomplete comparison to any
person for the purpose of inducing or tending to induce such person to
purchase, amend, lapse, forfeit, change, or surrender insurance. Any written statement
concerning the premiums for a policy which refers to the net cost after credit
for an assumed dividend, without an accurate written statement of the gross
premiums, cash values, and dividends based on the insurer's current dividend
scale, which are used to compute the net cost for such policy, and a prominent
warning that the rate of dividend is not guaranteed, is a misrepresentation for
the purposes of this division.
|
| (B) |
Making, publishing, disseminating, circulating, or placing before the public or
causing, directly or indirectly, to be made, published, disseminated,
circulated, or placed before the public, in a newspaper, magazine, or other
publication, or in the form of a notice, circular, pamphlet, letter, or poster,
or over any radio station, or in any other way, or preparing with intent to so
use, an advertisement, announcement, or statement containing any assertion,
representation, or statement, with respect to the business of insurance or with
respect to any person in the conduct of the person's insurance business, which
is untrue, deceptive, or misleading. |
| (C) |
Making, publishing, disseminating, or circulating, directly or indirectly, or
aiding, abetting, or encouraging the making, publishing, disseminating, or
circulating, or preparing with intent to so use, any statement, pamphlet,
circular, article, or literature, which is false as to the financial condition
of an insurer and which is calculated to injure any person engaged in the
business of insurance. |
| (D) |
Filing with
any supervisory or other public official, or making, publishing, disseminating,
circulating, or delivering to any person, or placing before the public, or
causing directly or indirectly to be made, published, disseminated, circulated,
delivered to any person, or placed before the public, any false statement of
financial condition of an insurer. Making any false entry in
any book, report, or statement of any insurer with intent to deceive any agent
or examiner lawfully appointed to examine into its condition or into any of its
affairs, or any public official to whom such insurer is required by law to
report, or who has authority by law to examine into its condition or into any
of its affairs, or, with like intent, willfully omitting to make a true entry
of any material fact pertaining to the business of such insurer in any book,
report, or statement of such insurer, or mutilating, destroying, suppressing,
withholding, or concealing any of its records.
|
| (E) |
Issuing or delivering or permitting agents, officers, or employees to issue or
deliver agency company stock or other capital stock or benefit certificates or
shares in any common-law corporation or securities or any special or advisory
board contracts or other contracts of any kind promising returns and profits as
an inducement to insurance. |
| (F) |
Making or permitting any unfair discrimination among individuals of the same
class and equal expectation of life in the rates charged for any contract of
life insurance or of life annuity or in the dividends or other benefits payable
thereon, or in any other of the terms and conditions of such
contract. |
| (G) |
| (1) |
Except as otherwise expressly provided by law, knowingly permitting or offering
to make or making any contract of life insurance, life annuity or accident and
health insurance, or agreement as to such contract other than as plainly
expressed in the contract issued thereon, or paying or allowing, or giving or
offering to pay, allow, or give, directly or indirectly, as inducement to such
insurance, or annuity, any rebate of premiums payable on the contract, or any
special favor or advantage in the dividends or other benefits thereon, or any
valuable consideration or inducement whatever not specified in the contract; or
giving, or selling, or purchasing, or offering to give, sell, or purchase, as
inducement to such insurance or annuity or in connection therewith, any stocks,
bonds, or other securities, or other obligations of any insurance company or
other corporation, association, or partnership, or any dividends or profits
accrued thereon, or anything of value whatsoever not specified in the
contract. |
| (2) |
Nothing in
division (F) or division (G)(1) of this section shall be construed as
prohibiting any of the following practices:
| (a) |
in
the case of any contract of life insurance or life annuity, paying bonuses to
policyholders or otherwise abating their premiums in whole or in part out of
surplus accumulated from nonparticipating insurance, provided that any such
bonuses or abatement of premiums shall be fair and equitable to policyholders
and for the best interests of the company and its policyholders; |
| (b) |
in
the case of life insurance policies issued on the industrial debit plan, making
allowance to policyholders who have continuously for a specified period made
premium payments directly to an office of the insurer in an amount which fairly
represents the saving in collection expenses; |
| (c) |
readjustment of the rate of premium for a group insurance policy based on the
loss or expense experience thereunder, at the end of the first or any
subsequent policy year of insurance thereunder, which may be made retroactive
only for such policy year. |
|
|
| (H) |
Making, issuing, circulating, or causing or permitting to be made, issued, or
circulated, or preparing with intent to so use, any statement to the effect
that a policy of life insurance is, is the equivalent of, or represents shares
of capital stock or any rights or options to subscribe for or otherwise acquire
any such shares in the life insurance company issuing that policy or any other
company. |
| (I) |
Making,
issuing, circulating, or causing or permitting to be made, issued or
circulated, or preparing with intent to so issue, any statement to the effect
that payments to a policyholder of the principal amounts of a pure endowment
are other than payments of a specific benefit for which specific premiums have
been paid. |
| (J) |
Making,
issuing, circulating, or causing or permitting to be made, issued, or
circulated, or preparing with intent to so use, any statement to the effect
that any insurance company was required to change a policy form or related
material to comply with Title XXXIX of the Revised Code or any regulation of
the superintendent of insurance, for the purpose of inducing or intending to
induce any policyholder or prospective policyholder to purchase, amend, lapse,
forfeit, change, or surrender insurance. |
| (K) |
Aiding or abetting another to violate this section. |
| (L) |
Refusing to issue any policy of insurance, or canceling or declining to renew
such policy because of the sex or marital status of the applicant, prospective
insured, insured, or policyholder. |
| (M) |
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. |
| (N) |
Refusing to make available disability income insurance solely because the
applicant's principal occupation is that of managing a household. |
| (O) |
Refusing, when offering maternity benefits under any individual or group
sickness and accident insurance policy, to make maternity benefits available to
the policyholder for the individual or individuals to be covered under any
comparable policy to be issued for delivery in this state, including family
members if the policy otherwise provides coverage for family members. Nothing
in this division shall be construed to prohibit an insurer from imposing a
reasonable waiting period for such benefits under an individual sickness and
accident insurance policy issued to an individual who is not a federally
eligible individual or a nonemployer-related group sickness and accident
insurance policy, but in no event shall such waiting period exceed two hundred
seventy days. For purposes of division
(O) of this section, "federally eligible individual" means an eligible
individual as defined in
45 C.F.R. 148.103.
|
| (P) |
Using, or permitting to be used, a pattern settlement as the basis of any offer
of settlement. As used in this division, "pattern settlement" means a method by
which liability is routinely imputed to a claimant without an investigation of
the particular occurrence upon which the claim is based and by using a
predetermined formula for the assignment of liability arising out of
occurrences of a similar nature. Nothing in this division shall be construed to
prohibit an insurer from determining a claimant's liability by applying
formulas or guidelines to the facts and circumstances disclosed by the
insurer's investigation of the particular occurrence upon which a claim is
based. |
| (Q) |
Refusing to
insure, or refusing to continue to insure, or limiting the amount, extent, or
kind of life or sickness and accident insurance or annuity coverage available
to an individual, or charging an individual a different rate for the same
coverage solely because of blindness or partial blindness. With respect to all
other conditions, including the underlying cause of blindness or partial
blindness, persons who are blind or partially blind shall be subject to the
same standards of sound actuarial principles or actual or reasonably
anticipated actuarial experience as are sighted persons. Refusal to insure
includes, but is not limited to, denial by an insurer of disability insurance
coverage on the grounds that the policy defines "disability" as being presumed
in the event that the eyesight of the insured is lost. However, an insurer may
exclude from coverage disabilities consisting solely of blindness or partial
blindness when such conditions existed at the time the policy was issued. To
the extent that the provisions of this division may appear to conflict with any
provision of section
3999.16
of the Revised Code, this division applies. |
| (R) |
| (1) |
Directly or indirectly offering to sell, selling, or delivering, issuing for
delivery, renewing, or using or otherwise marketing any policy of insurance or
insurance product in connection with or in any way related to the grant of a
student loan guaranteed in whole or in part by an agency or commission of this
state or the United States, except insurance that is required under federal or
state law as a condition for obtaining such a loan and the premium for which is
included in the fees and charges applicable to the loan; or, in the case of an
insurer or insurance agent, knowingly permitting any lender making such loans
to engage in such acts or practices in connection with the insurer's or agent's
insurance business. |
| (2) |
Except in
the case of a violation of division (G) of this section, division (R)(1) of
this section does not apply to either of the following:
| (a) |
Acts or practices of an insurer, its agents, representatives, or employees in
connection with the grant of a guaranteed student loan to its insured or the
insured's spouse or dependent children where such acts or practices take place
more than ninety days after the effective date of the insurance; |
| (b) |
Acts or practices of an insurer, its agents, representatives, or employees in
connection with the solicitation, processing, or issuance of an insurance
policy or product covering the student loan borrower or the borrower's spouse
or dependent children, where such acts or practices take place more than one
hundred eighty days after the date on which the borrower is notified that the
student loan was approved. |
|
|
| (S) |
Denying coverage, under any health insurance or health care policy, contract,
or plan providing family coverage, to any natural or adopted child of the named
insured or subscriber solely on the basis that the child does not reside in the
household of the named insured or subscriber. |
| (T) |
| (1) |
Using any underwriting standard or engaging in any other act or practice that,
directly or indirectly, due solely to any health status-related factor in
relation to one or more individuals, does either of the following:
| (a) |
Terminates or fails to renew an existing individual policy, contract, or plan
of health benefits, or a health benefit plan issued to an employer, for which
an individual would otherwise be eligible; |
| (b) |
With respect to a health benefit plan issued to an employer, excludes or causes
the exclusion of an individual from coverage under an existing
employer-provided policy, contract, or plan of health benefits. |
|
| (2) |
The
superintendent of insurance may adopt rules in accordance with Chapter 119. of
the Revised Code for purposes of implementing division (T)(1) of this
section. |
| (3) |
For purposes
of division (T)(1) of this section, "health status-related factor" means any of
the following:
| (b) |
Medical
condition, including both physical and mental illnesses; |
| (d) |
Receipt of
health care; |
| (g) |
Evidence of
insurability, including conditions arising out of acts of domestic
violence; |
|
|
| (U) |
With respect to a health benefit plan issued to a small employer, as those
terms are defined in section
3924.01
of the Revised Code, negligently or willfully placing coverage for adverse
risks with a certain carrier, as defined in section
3924.01
of the Revised Code. |
| (V) |
Using any
program, scheme, device, or other unfair act or practice that, directly or
indirectly, causes or results in the placing of coverage for adverse risks with
another carrier, as defined in section
3924.01
of the Revised Code. |
| (X) |
Intentionally establishing an unfair premium for, or misrepresenting the cost
of, any insurance policy financed under a premium finance agreement of an
insurance premium finance company. |
| (Y) |
| (1) |
| (a) |
Limiting coverage under, refusing to issue, canceling, or refusing to renew,
any individual policy or contract of life insurance, or limiting coverage under
or refusing to issue any individual policy or contract of health insurance, for
the reason that the insured or applicant for insurance is or has been a victim
of domestic violence; |
| (b) |
Adding a
surcharge or rating factor to a premium of any individual policy or contract of
life or health insurance for the reason that the insured or applicant for
insurance is or has been a victim of domestic violence; |
| (c) |
Denying coverage under, or limiting coverage under, any policy or contract of
life or health insurance, for the reason that a claim under the policy or
contract arises from an incident of domestic violence; |
| (d) |
Inquiring, directly or indirectly, of an insured under, or of an applicant for,
a policy or contract of life or health insurance, as to whether the insured or
applicant is or has been a victim of domestic violence, or inquiring as to
whether the insured or applicant has sought shelter or protection from domestic
violence or has sought medical or psychological treatment as a victim of
domestic violence. |
|
| (2) |
Nothing in division (Y)(1) of this section shall be construed to prohibit an
insurer from inquiring as to, or from underwriting or rating a risk on the
basis of, a person's physical or mental condition, even if the condition has
been caused by domestic violence, provided that all of the following apply:
| (a) |
The
insurer routinely considers the condition in underwriting or in rating risks,
and does so in the same manner for a victim of domestic violence as for an
insured or applicant who is not a victim of domestic violence; |
| (b) |
The
insurer does not refuse to issue any policy or contract of life or health
insurance or cancel or refuse to renew any policy or contract of life
insurance, solely on the basis of the condition, except where such refusal to
issue, cancellation, or refusal to renew is based on sound actuarial principles
or is related to actual or reasonably anticipated experience; |
| (c) |
The
insurer does not consider a person's status as being or as having been a victim
of domestic violence, in itself, to be a physical or mental
condition; |
| (d) |
The
underwriting or rating of a risk on the basis of the condition is not used to
evade the intent of division (Y)(1) of this section, or of any other provision
of the Revised Code. |
|
| (3) |
| (a) |
Nothing in division (Y)(1) of this section shall be construed to prohibit an
insurer from refusing to issue a policy or contract of life insurance insuring
the life of a person who is or has been a victim of domestic violence if the
person who committed the act of domestic violence is the applicant for the
insurance or would be the owner of the insurance policy or contract. |
| (b) |
Nothing in division (Y)(2) of this section shall be construed to permit an
insurer to cancel or refuse to renew any policy or contract of health insurance
in violation of the "Health Insurance Portability and Accountability Act of
1996," 110 Stat. 1955,
42 U.S.C.A. 300gg - 41(b), as amended, or in a manner
that violates or is inconsistent with any provision of the Revised Code that
implements the "Health Insurance Portability and Accountability Act of
1996." |
|
| (4) |
An insurer
is immune from any civil or criminal liability that otherwise might be incurred
or imposed as a result of any action taken by the insurer to comply with
division (Y) of this section. |
| (5) |
As
used in division (Y) of this section, "domestic violence" means any of the
following acts:
| (a) |
Knowingly
causing or attempting to cause physical harm to a family or household
member; |
| (b) |
Recklessly
causing serious physical harm to a family or household member; |
| (c) |
Knowingly causing, by threat of force, a family or household member to believe
that the person will cause imminent physical harm to the family or household
member. For the purpose of
division (Y)(5) of this section, "family or household member" has the same
meaning as in section
2919.25 of the
Revised Code. Nothing in division
(Y)(5) of this section shall be construed to require, as a condition to the
application of division (Y) of this section, that the act described in division
(Y)(5) of this section be the basis of a criminal prosecution.
|
|
|
| (Z) |
Disclosing a
coroner's records by an insurer in violation of section
313.10
of the Revised Code. |
| (AA) |
Making,
issuing, circulating, or causing or permitting to be made, issued, or
circulated any statement or representation that a life insurance policy or
annuity is a contract for the purchase of funeral goods or services. |
| (BB) |
With respect to a health care contract as defined in
section
3963.01
of the Revised Code that covers vision services, as defined in that section,
including any of the contract terms prohibited under or failing to make the
disclosures required under division (E) of section
3963.02
of the Revised Code. |
| (CC) |
With respect to private passenger automobile insurance, charging premium rates
that are excessive, inadequate, or unfairly discriminatory, pursuant to
division (D) of section
3937.02
of the Revised Code, based solely on the location of the residence of the
insured. The enumeration in
sections
3901.19
to
3901.26
of the Revised Code 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 this
section, or to take action under other sections of the Revised Code. This section does not
prohibit the sale of shares of any investment company registered under the
"Investment Company Act of 1940," 54 Stat. 789,
15 U.S.C.A. 80a-1, as amended, or any policies,
annuities, or other contracts described in section
3907.15 of
the Revised Code. As used in this section,
"estimate," "statement," "representation," "misrepresentation,"
"advertisement," or "announcement" includes oral or written occurrences.
|
Amended by
132nd General Assembly File No. TBD, HB 156, §1,
eff. 3/20/2019.
Amended by
129th General AssemblyFile No.181, HB 278,
§1, eff.
3/22/2013.
Effective Date:
03-22-1999; 08-17-2006; 2008 SB196 07-06-2009 .
| (A) |
| (1) |
No person may require as a condition precedent to
the lending of money or the extension of credit, or any renewal thereof, that
the person to whom such money or credit is extended or whose obligation a
creditor is to acquire or finance, negotiate any policy or renewal thereof
through a particular insurer or group of insurers or agent or group of agents.
|
| (2) |
No person may reject an
insurance policy solely because the policy has been issued or underwritten by a
person that is not associated with the person, or an affiliate of the person,
rejecting the policy. |
|
| (B) |
No person that lends money or extends credit may
do any of the following:
| (1) |
As a condition
for extending credit or offering any product or service that is equivalent to
an extension of credit, require that a customer obtain insurance from a
depository institution or an affiliate of a depository institution, or from a
particular insurer, agent, or other person. However, this provision does not
prohibit a person from informing a customer or prospective customer that
insurance is required in order to obtain a loan or credit, that loan or credit
approval is contingent upon the procurement by the customer of acceptable
insurance, or that insurance is available from the person or an affiliate of
that person. |
| (2) |
Unreasonably
reject a policy furnished by the customer or borrower for the protection of the
property securing the credit or lien. A rejection shall not be deemed
unreasonable if it is based on reasonable standards, uniformly applied. Such
standards may include, but are not limited to, standards relating to the extent
of coverage required and the financial soundness and services of an insurer.
Such standards shall not discriminate against any particular type of insurer,
nor shall such standards call for the rejection of a policy because it contains
coverage in addition to that required in the credit transaction. |
| (3) |
Require that any customer, borrower,
mortgagor, purchaser, insurer, broker, or agent pay a separate charge in
connection with the handling of any policy required as security for a loan on
real estate or pay a separate charge to substitute the policy of one insurer
for that of another. Division (B)(3) of this section does not apply to the
interest that may be charged on premium loans or premium advancements in
accordance with the terms of the loan or credit document. Division (B)(3) of
this section does not apply to required charges when the person or an affiliate
of that person is the licensed agent providing the insurance. |
| (4) |
Require any procedures or conditions of
duly licensed agents or insurers not customarily required of the agents or
insurers affiliated, or in any way connected, with the person that lends money
or extends credit; |
| (5) |
Use an
advertisement or other insurance promotional material that would cause a
reasonable person to mistakenly believe that the federal government or the
state is responsible for the insurance sales activity of, or stands behind the
credit of, the person, depository institution, or an affiliate of the person or
depository institution; |
| (6) |
Use an
advertisement or other insurance promotional material that would cause a
reasonable person to mistakenly believe that the federal government or the
state guarantees any return on insurance products or is a source of payment on
any insurance obligation of or sold by the person or an affiliate of the
person; |
| (7) |
Pay or receive any
commission, brokerage fee, or other compensation as an agent, unless the person
holds a valid agent's license for the applicable class of insurance. However,
an unlicensed person may make a referral to a licensed agent, provided that the
person does not discuss specific insurance policy terms and conditions. The
unlicensed person may be compensated for the referral; however, in the case of
a referral of a customer, the unlicensed person may be compensated only if the
compensation is a fixed dollar amount for each referral that does not depend on
whether the customer purchases the insurance product from the licensed agent.
Further, any person that accepts deposits from the public in an area where such
transactions are routinely conducted in the depository institution may receive
for each customer referral no more than a one-time, nominal fee of a fixed
dollar amount that does not depend on whether the referral results in a
transaction. |
| (8) |
Solicit or sell
insurance, other than credit insurance or flood insurance, unless the
solicitation or sale is completed through documents separate from any credit
transactions; |
| (9) |
Include the
expense of insurance premiums, other than credit insurance premiums or flood
insurance premiums, in the primary credit transaction without the express
written consent of the customer; |
| (10) |
As a condition of financing a
residential mortgage or providing other financing arrangements for residential
property, including a mobile or manufactured home, require a mortgagor or
borrower to purchase homeowners insurance coverage or other residential
property insurance coverage in an amount that exceeds the replacement value of
the dwelling and its contents, regardless of the amount of mortgage or other
financing arrangement entered into by the mortgagor or borrower. The fair
market value of the land on which the dwelling is located shall not be included
in the replacement value of the dwelling and its contents. |
|
| (C) |
| (1) |
If an application for a loan or extension of credit is pending before a person
that lends money or extends credit and that also solicits insurance primarily
for personal, family, or household purposes in connection with that loan or
extension of credit, that person shall disclose to the customer, in writing,
that the insurance related to the credit extension may be purchased from an
insurer or agent of the customer's choice, subject only to the lender's right
to reject a given insurer or agent as provided in division (B)(2) of this
section. Further, the disclosure shall inform the customer that the customer's
choice of an insurer or agent will not affect the credit decision or credit
terms in any way, except that the person lending money or extending credit may
impose reasonable requirements as provided in division (B)(2) of this section.
|
| (2) |
If an application for a loan
or extension of credit is pending before a person that lends money or extends
credit and that also solicits insurance primarily for personal, family, or
household purposes in connection with that loan or extension of credit, that
person shall obtain a written acknowledgement of the receipt of the disclosure
at the time the customer receives the disclosure or at the time of the initial
purchase of the insurance policy. If the solicitation is conducted by
telephone, the person shall obtain an oral acknowledgement of receipt of the
disclosure, maintain sufficient documentation to show that the acknowledgement
was given by the customer, and make reasonable efforts to obtain a written
acknowledgement from the customer. If a customer affirmatively consents to
receiving the disclosures electronically and the disclosures are provided in a
format that the customer may retain or obtain later, the person may provide the
disclosure and obtain acknowledgement of the receipt of the disclosure from the
customer using electronic media. |
| (3) |
This division does not apply to the offering or
sale of limited line credit insurance as defined in section
3905.01 of the Revised Code.
|
|
| (D) |
| (1) |
A depository institution that solicits, sells,
advertises, or offers insurance, and any person that solicits, sells,
advertises, or offers insurance on behalf of a depository institution or on the
premises of a depository institution, shall disclose to the customer in
writing, where practicable and in a clear and conspicuous manner, prior to a
sale, that the insurance:
| (b) |
Is not insured by the
federal deposit insurance corporation or any other federal government agency;
|
| (c) |
Is not guaranteed by the
depository institution, and, when applicable, that the insurance is not
guaranteed by an affiliate of the depository institution or by any person that
is soliciting, selling, advertising, or offering insurance; |
| (d) |
Involves investment risk including the
possible loss of value, where this disclosure is appropriate.
|
|
| (2) |
A depository
institution that solicits, sells, advertises, or offers insurance, and any
person that solicits, sells, advertises, or offers insurance on behalf of a
depository institution or on the premises of a depository institution, shall
obtain written acknowledgement of the receipt of the disclosure from the
customer at the time the customer receives the disclosure or at the time of the
initial purchase of the insurance policy. If the solicitation is conducted by
telephone, the person or depository institution shall obtain an oral
acknowledgement of receipt of the disclosure, maintain sufficient documentation
to show that the acknowledgement was given by the customer, and make reasonable
efforts to obtain a written acknowledgement from the customer. If a customer
affirmatively consents to receiving the disclosures electronically and the
disclosures are provided in a format that the customer may retain or obtain
later, the person or depository institution may provide the disclosure and
obtain acknowledgement of the receipt of the disclosure from the customer using
electronic media. |
| (3) |
For
purposes of divisions (D)(1) and (2) of this section, an affiliate of a
depository institution is subject to these requirements only to the extent that
it sells, solicits, advertises, or offers insurance products or annuities at an
office of a depository institution or on behalf of a depository institution.
These requirements apply only when an individual purchases, applies to
purchase, or is solicited to purchase insurance products or annuities primarily
for personal, family, or household purposes and only to the extent that a
disclosure would be accurate. |
| (4) |
For purposes of division (D)(1) of this section, a person is selling,
soliciting, advertising, or offering insurance on behalf of a depository
institution, whether at an office of the depository institution or another
location, if at least one of the following applies:
| (a) |
The person represents to the customer
that the sale, solicitation, advertisement, or offer of insurance is by or on
behalf of the depository institution; |
| (b) |
The depository institution refers a
customer to the person that sells insurance and the depository institution has
a contractual arrangement to receive commissions or fees derived from the sale
of insurance resulting from the referral; |
| (c) |
Documents evidencing the sale,
solicitation, advertisement, or offer of insurance identify or refer to the
depository institution. |
|
|
| (E) |
Nothing in this section shall prevent a person
that lends money or extends credit from placing insurance on real or personal
property in the event the mortgagor, borrower, or purchaser has failed to
provide required insurance in accordance with the terms of the loan or credit
document. |
| (F) |
| (1) |
A violation of this section is an unfair and
deceptive act or practice in the business of insurance under sections
3901.19 to
3901.26 of the Revised Code.
|
| (2) |
Any person subject to this
section shall, upon reasonable notice, make available to the superintendent of
insurance all books and records relating to insurance transactions. |
|
Effective Date:
09-01-2002;
04-27-2005 .
| (A) |
The
superintendent of insurance may conduct hearings to determine whether
violations of section
3901.20 of the Revised Code have
occurred. Any person aggrieved with respect to any act that the person believes
to be an unfair or deceptive act or practice in the business of insurance, as
defined in section
3901.21 or
3901.211 of the Revised Code or in
any rule of the superintendent, may make written application to the
superintendent for a hearing to determine if there has been a violation of
section 3901.20 of the Revised Code. The
application shall specify the grounds to be relied upon by the applicant. If
the superintendent finds that the application is made in good faith, that the
applicant would be so aggrieved if the applicant's grounds are established, and
that such grounds otherwise justify holding such a hearing, the superintendent
shall hold a hearing to determine whether the act specified in the application
is a violation of section
3901.20 of the Revised Code.
Notice of any hearing held under the authority of this section, the conduct of
the hearing, the orders issued pursuant to it, the review of the orders and all
other matters relating to the holding of the hearing shall be governed by
Chapter 119. of the Revised Code. |
| (B) |
Upon good cause shown, the superintendent shall
permit any person to intervene, appear, and be heard at the hearing, either in
person or by counsel. |
| (C) |
The
superintendent shall send a copy of the order to those persons intervening in
the hearing. |
| (D) |
If the
superintendent, by written order, finds that any person has violated section
3901.20 of the Revised Code, the
superintendent shall issue an order requiring that person to cease and desist
from engaging in the violation. In addition, the superintendent may impose any
or all of the following administrative remedies upon the person:
| (1) |
The superintendent may suspend or revoke
the person's license to engage in the business of insurance; |
| (2) |
The superintendent may order that an
insurance company or insurance agency not employ the person or permit the
person to serve as a director, consultant, or in any other capacity for such
time as the superintendent determines would serve the public interest. No
application for termination of such an order for an indefinite time shall be
filed within two years of its effective date. |
| (3) |
The superintendent may order the person
to return any payments received by the person as a result of the violation;
|
| (4) |
If the superintendent issues an
order pursuant to division (D)(3) of this section, the superintendent shall
order the person to pay statutory interest on such payments. If the superintendent does not issue orders pursuant to
divisions (D)(3) and (4) of this section, the superintendent shall expressly
state in the cease-and-desist order the reasons for not issuing such orders.
|
| (5) |
The superintendent may
order the person to pay to the state treasury for credit to the department's
operating fund an amount, not in excess of one hundred thousand dollars, equal
to one-half of the expenses reasonably incurred by the superintendent to retain
attorneys, actuaries, accountants, and other experts not otherwise a part of
the superintendent's staff to assist directly in the conduct of any
investigations and hearings conducted with respect to violations committed by
the person. |
|
| (E) |
If the
superintendent has reasonable cause to believe that an order issued pursuant to
division (D) of this section has been violated in whole or in part, the
superintendent may, unless such order is stayed by a court of competent
jurisdiction, request the attorney general to commence and prosecute any
appropriate action or proceeding in the name of the state against the person. Such action may include, but need not be limited to, the
commencement of a class action under Civil Rule 23 on behalf of policyholders,
subscribers, applicants for policies or contracts, or other insurance consumers
for damages caused by or unjust enrichment received as a result of the
violation.
|
| (F) |
In addition
to any penalties imposed pursuant to this chapter, the court may, in an action
brought pursuant to division (E) of this section, impose any of the following:
| (1) |
For each act or practice found to be in
violation of section
3901.20 of the Revised Code, a
civil penalty of not more than three thousand five hundred dollars for each
violation but not to exceed an aggregate penalty of thirty-five thousand
dollars in any six-month period, provided that a series of similar acts or
practices prohibited by section
3901.20 of the Revised Code and
committed by the same person but not in separate insurance sales transactions
shall be considered a single violation; |
| (2) |
For each violation of a cease and desist
order issued by the superintendent pursuant to this section, a civil penalty of
not more than ten thousand dollars; |
| (3) |
In addition to any other appropriate
relief, the court may order any or all of the remedies specified in division
(D) of this section. |
|
| (G) |
The superintendent, under a settlement agreement
to which a person has consented in writing for the purpose of assuring the
person's correction of a series of offenses and future compliance with the laws
of this state relating to the business of insurance, may impose a single
penalty in whatever amount the parties determine to be justified under the
circumstances. |
| (H) |
A court of
common pleas, in a civil action commenced by the attorney general on behalf of
the superintendent under Civil Rule 65, may grant a temporary restraining
order, preliminary injunction, or permanent injunction to restrain or prevent a
violation or threatened violation of any provision of section
3901.20 of the Revised Code, if
the court finds that the defendant has violated, is violating, or is
threatening to violate such provision, that immediate and irreparable injury,
loss, or damage will result if such relief is not granted, and that no adequate
remedy at law exists to prevent such irreparable injury, loss, or damage.
|
| (I) |
If the superintendent's
position in initiating a matter in controversy pursuant to this section and
section 3901.221 of the Revised Code was
not substantially justified, upon motion of the person who prevailed in the
hearing or in the appropriate court, if an adjudication order was appealed or a
civil action was commenced, the superintendent or the court shall order the
department of insurance to pay such person an amount, not in excess of one
hundred thousand dollars, equal to one-half of the expenses reasonably incurred
by the person in connection with the related proceedings. An award pursuant to
this division may be reduced or denied if special circumstances make an award
unjust or if the person engaged in conduct that unduly and unreasonably
protracted the final resolution of the matter in controversy. If the department
does not pay such award or no such funds are available, the award shall be
treated as if it were a judgment under Chapter 2743. of the Revised Code and be
payable in accordance with the procedures specified in section
2743.19 of the Revised Code,
except that interest shall not be paid in relation to the award. |
Effective Date:
09-01-2002 .
If a violation of section
3901.20 of the Revised Code has
caused, is causing, or is about to cause substantial and material harm, the
superintendent of insurance may issue an order that the person cease and desist
from any activity violating such section. Notice of the order shall be mailed
by certified mail, return receipt requested, or served in any manner provided
in section
3901.04 of the Revised Code,
immediately after its issuance by the superintendent to the person subject to
the order and to all persons known to be involved in the violation. The
superintendent may thereafter publicize or otherwise make known to all
interested persons that the order has been issued.
The notice shall specify the particular act, omission,
practice, or transaction that is subject to the cease-and-desist order and
shall set a date, not more than fifteen days after the date of the
cease-and-desist order, for a hearing on the continuation or revocation of the
order. The person shall comply with the order immediately upon receipt of
notice of the order. The superintendent may, upon the application of a party
and for good cause shown, continue the hearing. Chapter 119. of the Revised
Code applies to such hearings to the extent that that chapter does not conflict
with the procedures set forth in this section. The superintendent shall, within
fifteen days after objections are submitted to the hearing officer's report and
recommendation, issue a final order either confirming or revoking the
cease-and-desist order. The final order may be appealed as provided under
section 119.12 of the Revised Code. The
remedy under this section is cumulative and concurrent with the remedies
available under section
3901.22 of the Revised Code and
may be enforced by the attorney general at the request of the superintendent as
provided in division (E) of that section.
Effective Date:
01-05-1988 .
If any person asks to be excused from attending and testifying
or from producing any books, papers, records, correspondence, or other
documents at any hearing on the ground that the testimony or evidence required
of him may tend to incriminate him or subject him to a penalty or forfeiture
and notwithstanding is directed to give such testimony or produce such
evidence, he must none the less comply with such direction, but he shall not
thereafter be prosecuted or subjected to any penalty or forfeiture for or on
account of any transaction, matter, or thing concerning which he may testify or
produce evidence pursuant thereto. No testimony so given or evidence produced
shall be received against him upon any criminal action, investigation, or
proceeding, provided that no such individual so testifying shall be exempt from
prosecution or punishment for any perjury committed by him while so testifying.
The testimony or evidence so given or produced shall be admissible against him
upon any criminal action, investigation, or proceeding concerning such perjury.
No such individual so testifying shall be exempt from the refusal, revocation,
or suspension of any license, permission, or authority conferred, or to be
conferred, pursuant to the insurance law of this state. Any such individual may
execute, acknowledge, and file in the office of the superintendent of insurance
a statement expressly waiving such immunity or privilege in respect to any
transaction, matter, or thing specified in such statement; thereupon the
testimony of such person or such evidence in relation to such transaction,
matter, or thing may be received or produced before any judge or justice,
court, tribunal, grand jury, or otherwise, and if so received or produced, such
individual shall not be entitled to any immunity or privilege on account of any
testimony he may so give or evidence so produced.
Effective Date:
01-10-1961 .
No unauthorized foreign or alien insurer shall make, issue,
circulate, or cause to be made, issued, or circulated, to residents of this
state any estimate, illustration, circular, pamphlet, or letter, or cause to be
made in any newspaper, magazine or other publication or over any radio or
television station, any announcement or statement to such residents
misrepresenting its financial condition or the terms of any contracts issued or
to be issued or the benefits or advantages promised thereby, or the dividends
or share of the surplus to be received thereon in violation of sections
3901.19 to
3901.26, inclusive, of the Revised
Code, and whenever the superintendent of insurance has reason to believe that
any such insurer is engaging in such unlawful advertising, he shall give notice
of such fact by registered mail to such insurer and to the insurance
supervisory official of the domiciliary state of such insurer. For the purpose
of this section, the domiciliary state of an alien insurer shall be deemed to
be the state of entry or the state of the principal office in the United
States.
Effective Date:
02-21-1967 .
| (A) |
As used in this
section:
| (1) |
"Exchange" has the same
meaning as in section
3905.01 of the Revised
Code. |
| (2) |
"Enrollee's expected
contribution" means any portion of the cost of a health service covered by a
health benefit plan offered through an exchange that a person enrolled under
such a plan would be expected to pay, including any copayments or cost
sharing. |
|
| (B) |
| (1) |
An insurer offering a health benefit plan through an
exchange shall make available to individuals seeking information on the plan a
list of the top twenty per cent of services, according to utilization of health
services by individuals insured by the insurer, and an enrollee's expected
contribution for each service. |
| (2) |
The enrollee's expected
contribution for each service shall be provided both for situations in which
the enrollee has and has not met any associated deductibles. |
|
| (C) |
A violation of division
(B) of this section shall be considered an unfair and deceptive practice in the
business of insurance under section
3901.21 of the Revised
Code. |
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
If after thirty days following the giving of the notice
mentioned in section
3901.24 of the Revised Code such
insurer has failed to cease making, issuing, or circulating such false
misrepresentations or causing the same to be made, issued, or circulated in
this state, and if the superintendent of insurance has reason to believe that a
proceeding by him in respect to such matters would be to the interest of the
public, and that such insurer is issuing or delivering contracts of insurance
to residents of this state or collecting premiums on such contracts or doing
any of the acts enumerated in section
3901.26 of the Revised Code, he
shall take action against such insurer under sections
3901.19 to
3901.26, inclusive, of the Revised
Code.
Effective Date:
02-21-1967 .
| (A) |
Any of the
following acts in this state, effected by mail or otherwise, by any such
unauthorized foreign or alien insurer; (1) the issuance or delivery of
contracts or insurance to residents of this state, (2) the solicitation of
applications for such contracts, (3) the collection of premiums, membership
fees, assessments, or other considerations for such contracts, or (4) any other
transaction of insurance business, is equivalent to and constitutes an
appointment by such insurer of the superintendent of insurance and his
successor or successors in office, to be its true and lawful attorney, upon
whom may be served all statements of charges, notices, and lawful process in
any proceeding instituted in respect to the misrepresentations set forth in
section 3901.24 of the Revised Code under
sections 3901.19 to 3901.26, inclusive, of
the Revised Code, or in any action, suit, or proceeding for the recovery of any
penalty therein provided, and any such act shall be signification of its
agreement that such service of statement of charges, notices, or process is of
the same legal force and validity as personal service of such statement of
charges, notices, or process in this state, upon such insurer. |
| (B) |
Service of a statement of charges and
notices under sections
3901.19 to 3901.26, inclusive, of
the Revised Code, shall be made by any deputy or employee of the department of
insurance delivering to and leaving with the superintendent or some person in
apparent charge of his office, two copies thereof. Service of process issued by
any court in any action, suit, or proceeding to collect any penalty under said
sections, shall be made by delivering and leaving with the superintendent, or
some person in apparent charge of his office, two copies thereof. The
superintendent shall forthwith cause to be mailed by registered mail one of the
copies of such statement of charges, notices, or process to the defendant at
its last known principal place of business, and shall keep a record of all
statements, charges, notices, and processes so served. Such service of
statement of charges, notices, or process shall be sufficient provided they
shall have been so mailed and the defendant's receipt or receipt issued by the
post office with which the letter is registered, showing the name of the sender
of the letter and the name and address of the person to whom the letter is
addressed, and the affidavit of the person mailing such letter showing a
compliance herewith are filed with the superintendent in the case of any
statement of charges or notices, or with the clerk of the court in which such
action is pending in the case of any process, on or before the date the
defendant is required to appear or within such further time as may be allowed.
|
| (C) |
Service of statement of
charges, notices, and process in any such proceeding, action, or suit shall in
addition to the manner provided in division (B) of this section be valid if
served upon any person within this state who on behalf of such insurer is (1)
soliciting insurance, or (2) making, issuing, or delivering any contract of
insurance, or (3) collecting or receiving in this state any premium for
insurance; and a copy of such statement of charges, notices, or process is sent
within ten days thereafter by registered mail by or on behalf of the
superintendent to the defendant at the last known principal place of business
of the defendant, and the defendant's receipt, or the receipt issued by the
post office with which the letter is registered, showing the name of the sender
of the letter, the name and address of the person to whom the letter is
addressed, and the affidavit of the person mailing the same showing a
compliance herewith, are filed with the superintendent in the case of any
statement of charges or notices, or with the clerk of the court in which such
action is pending in the case of any process, on or before the date the
defendant is required to appear or within such further time as the court may
allow. |
| (D) |
No cease or desist
order or judgment under this section shall be entered until the expiration of
thirty days from the date of the filing of the affidavit of compliance.
|
| (E) |
Service of process and notice
under sections
3901.19 to 3901.26, inclusive, of
the Revised Code, shall be in addition to all other methods of service provided
by law, and nothing in these sections shall limit to prohibit the right to
serve any statement of charges, notices, or process upon any insurer in any
other manner permitted by law. |
Effective Date:
09-15-1965 .
The board of directors of any domestic insurance company may at
any time adopt emergency bylaws, subject to repeal or change by action of those
having power to adopt regular bylaws for the company, which shall be operative
during an emergency, and which may, notwithstanding any different provisions of
the regular bylaws, or of the applicable statutes, or of the company's charter,
make any provision reasonably necessary for the operation of the company during
the period of such emergency. An emergency shall exist when the president of
the United States or the congress of the United States proclaims a national
emergency because of an attack on the United States by nuclear or atomic
weapons, or similar disaster, or when the governor of this state proclaims an
emergency for corporations as described in division (U) of section
1701.01 of the Revised Code.
Effective Date:
11-11-1965 .
In the event that the board of directors of a domestic
insurance company has not adopted emergency bylaws, the following provisions
shall become effective upon the occurrence of an emergency as described in
section 3901.27 of the Revised Code.
| (A) |
Three directors shall constitute
a quorum for the transaction of business at all meetings of the board.
|
| (B) |
Any vacancy in the board may
be filled by a majority of the remaining directors, though less than a quorum,
or by a sole remaining director. |
| (C) |
If there are no surviving directors, but at least
three vice-presidents of the company survive, the three vice-presidents with
the longest term of service shall be the directors and shall possess all of the
powers of the previous board of directors and such powers as are granted herein
or by subsequently enacted legislation. By majority vote, said emergency board
of directors may elect other directors. If there are not at least three
surviving vice-presidents, the superintendent of insurance or duly designated
person exercising the powers of the superintendent shall appoint three persons
as directors who shall possess all of the powers of the previous board of
directors and such powers as are granted herein or by subsequently enacted
legislation, and these directors may, by majority vote, elect other directors.
|
Effective Date:
11-11-1965 .
At any time, the board of directors of a domestic insurance
company may, by resolution, provide that in the event of an emergency, as
described in section
3901.27 of the Revised Code, and
in the event of the death or incapacity of the president, the secretary, or the
treasurer of the company, such officers or any of them shall be succeeded in
the office by the person named or described in a succession list adopted by the
board of directors. Such list may be on the basis of named persons or position
titles, and shall establish the order of priority and prescribe the conditions
under which the powers of the office shall be exercised.
Effective Date:
11-11-1965 .
At any time, the board of directors of a domestic insurance
company may, by resolution, provide that in the event of an emergency, as
described in section
3901.27 of the Revised Code, the
home office or principal place of business of the company shall be at such
location as is named or described in the resolution. Such resolution may
provide for alternate locations and establish an order of preference.
Effective Date:
11-11-1965 .
| (A) |
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
which is not a wholly owned subsidiary of an insurance holding company system
or who is a director or officer of such company, shall file with the
superintendent of insurance 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, shall 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. |
| (B) |
For the purpose of preventing the unfair use of information which may have been
obtained by such beneficial owner, director, or officer by reason of the
beneficial owner's, director's, or officer's relationship to such company, any
profit realized by the beneficial owner, director, or officer from any purchase
and sale, or any sale and purchase, of any equity security of such company
within any period of less than six months, unless such security was acquired in
good faith in connection with a debt previously contracted, shall inure to and
be recoverable by the company, irrespective of any intention on the part of
such beneficial owner, director, or officer in entering into such transaction
of holding the security purchased or of not repurchasing the security sold for
a period exceeding six months. Suit to recover such profit may be instituted at
law or in equity in any court of competent jurisdiction by the company, or by
the owner of any security of the company in the name and in behalf of the
company if the company fails or refuses to bring such suit within sixty days
after request or fails diligently to prosecute the same thereafter; but no such
suit shall be brought more than two years after the date such profit was
realized. Division (B) of this section shall not be construed to cover any
transaction where such beneficial owner was not such both at the time of
purchase and sale, or the sale and purchase, of the security involved, or any
transaction or transactions which the superintendent of insurance by rules may
exempt as not comprehended within the purpose of division (B) of this section.
|
| (C) |
No such beneficial owner,
director, or officer, directly or indirectly, shall sell any equity security of
such company if the person selling the security or the person's principal does
not own the security sold, or if owning the security, does not deliver it
against such sale within twenty days thereafter, or does not within five days
after such sale deposit it in the mails or other usual channels of
transportation; but no person shall be deemed to have violated division (C) of
this section if the person proves that notwithstanding the exercise of good
faith the person was unable to make such delivery or deposit within such time,
or that to do so would cause undue inconvenience or expense. |
| (D) |
A domestic insurance company having at
least fifty shareholders or any other person soliciting proxies with respect to
such domestic insurance company shall not solicit voting proxies from any
shareholder or other person except upon a proxy statement and pursuant to a
notice of meeting, which statement and notice have been submitted to the
superintendent of insurance at least ten days prior to being mailed to the
intended recipients. Such proxy statement and notice of meeting shall make such
disclosures pertinent to the business to be carried on at the meeting or
meetings with respect to which such proxies are solicited and such notices are
given as the superintendent by rule requires. The superintendent shall retain
such proxy material for examination by any interested party for at least one
year. |
| (E) |
Division (B) of this
section does not apply to any purchase and sale, or sale and purchase, and
division (C) of this section does not apply to any sale, of an equity security
of a domestic stock insurance company not then or theretofore held in an
investment account, by a dealer in the ordinary course of the dealer's business
and incident to the establishment or maintenance by the dealer of a primary or
secondary market for such security. The superintendent of insurance may, by
such rules as the superintendent considers necessary or appropriate in the
public interest, describe and define the terms and conditions with respect to
securities held in an investment account and transactions made in the ordinary
course of business and incident to the establishment or maintenance of a
primary or secondary market. |
| (F) |
Divisions (A), (B), and (C) of this section do not apply to foreign or domestic
arbitrage transactions unless made in contravention of such rules as the
superintendent of insurance may adopt in order to carry out the purposes of
this section. |
| (G) |
"Equity
security" when used in this section means any stock or similar security; or any
security convertible, with or without consideration, into such a security, or
carrying any warrant or right to subscribe to or purchase such a security; or
any such warrant or right; or any other security which the superintendent of
insurance determines to be of similar nature and considers necessary or
appropriate, by such rules as the superintendent may prescribe in the public
interest or for the protection of investors, to treat as an equity security.
|
| (H) |
The superintendent of
insurance may 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 this section. |
| (I) |
This
section applies to health insuring corporations in the same manner in which
this section applies to domestic stock insurance companies. |
Effective Date:
06-04-1997 .
As used in sections
3901.32 to
3901.37 of the Revised
Code:
| (A) |
"Affiliate
of" or "affiliated with" a specific person means a person that, directly or
indirectly, through one or more intermediaries, controls, is controlled by, or
is under common control with, the person specified. |
| (B) |
"Control," including "controlling," "controlled by," and "under common control
with," means the possession, direct or indirect, of the power to direct or
cause the direction of the management and policies of a person, whether through
the ownership of voting securities, by contract other than a commercial
contract for goods or nonmanagement services, or otherwise, unless the power is
the result of an official position with or corporate office held by the person.
Control shall be presumed to exist if any person, directly or indirectly, owns,
controls, holds with the power to vote, or holds proxies representing, ten per
cent or more of the voting securities of any other person. This presumption may
be rebutted by a showing made in the manner provided in division (J) of section
3901.33 of the Revised Code that
control does not exist in fact. The superintendent of insurance may determine,
after furnishing all persons in interest notice and opportunity to be heard and
making specific findings of fact to support such determination, that control
exists in fact, notwithstanding the absence of a presumption to that
effect. |
| (C) |
"Enterprise
risk" means any activity, circumstance, event, or series of events involving
one or more affiliates of an insurer that, if not remedied promptly, is likely
to have a materially adverse effect on the financial condition or liquidity of
the insurer or its insurance holding company system as a whole. "Enterprise
risk" includes anything that would cause the insurer's risk-based capital to
fall into company action level as set forth in section
3903.83 of the Revised Code or
would cause the insurer to be in a hazardous financial condition. |
| (D) |
"Group-wide supervisor" means the regulatory official
who is authorized by the superintendent to conduct and coordinate group-wide
supervision of an internationally active insurance group and who is determined
by the superintendent pursuant to division (A) of section 3901.352 of the
Revised Code to have sufficient contacts with the internationally active
insurance group. |
| (E) |
"Insurance
holding company system" means two or more affiliated persons, one or more of
which is an insurer. |
| (F) |
"Insurer" means any person engaged in the business
of insurance, guaranty, or membership, an inter-insurance exchange, a mutual or
fraternal benefit society, or a health insuring corporation. "Insurer" does not
include any agency, authority, or instrumentality of the United States, its
possessions and territories, the Commonwealth of Puerto Rico, the District of
Columbia, or a state or political subdivision of a state. |
| (G) |
"Internationally active insurance group" means an
insurance holding company system that includes an insurer registered under
section 3901.33 of the Revised Code and
that meets all of the following criteria:
| (1) |
Insurers that are part of the insurance holding
company system write premiums in at least three countries. |
| (2) |
The percentage of gross premiums written outside the
United States by the insurance holding company system is at least ten per cent
of the system's total gross written premiums. |
| (3) |
Based on a three-year rolling average, either the
total assets of the insurance holding company system are at least fifty billion
dollars, or the total gross written premiums of the insurance holding company
system are at least ten billion dollars. |
|
| (H) |
"Person" means an individual, a corporation, a partnership, an association, a
joint stock company, a trust, an unincorporated organization, any similar
entity, or any combination of the foregoing acting in concert. |
| (I) |
"Subsidiary" of
a specified person is an affiliate controlled by such person, directly or
indirectly, through one or more intermediaries. |
| (J) |
"Voting
security" includes any security convertible into or evidencing a right to
acquire a voting security. |
Amended by
132nd General Assembly File No. TBD, SB 169, §1,
eff. 6/21/2018.
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 06-04-1997
.
| (A) |
For the purposes of this section:
| (1) |
"Acquiring party" means any person by whom or on whose behalf a merger or other
acquisition of control is to be effected. |
| (2) |
"Domestic insurer" includes any person controlling a domestic insurer unless
the person, as determined by the superintendent of insurance, is either
directly or through its affiliates primarily engaged in business other than the
business of insurance. |
| (3) |
"Person"
does not include any securities broker holding, in the usual and customary
broker's function, less than twenty per cent of the voting securities of an
insurance company or of any person that controls an insurance
company. |
|
| (B) |
| (1) |
Subject to compliance with division (B)(2) of this
section, no person other than the issuer shall do any of the following if, as a
result, the person would, directly or indirectly, including by means of
conversion or the exercise of any right to acquire, be in control of a domestic
insurer:
| (a) |
Make a
tender offer for any voting security of a domestic insurer; |
| (b) |
Make a request or invitation for tenders of any voting security of a domestic
insurer; |
| (c) |
Enter into
any agreement to exchange securities of a domestic insurer; |
| (d) |
Seek to acquire or acquire, in the open market or otherwise, any voting
security of a domestic insurer; |
| (e) |
Enter into an agreement to merge with, or otherwise to acquire control of, a
domestic insurer. |
|
| (2) |
| (a) |
No
person shall engage in any transaction described in division (B)(1) of this
section, unless all of the following conditions are met:
| (i) |
The
person has filed with the superintendent of insurance a statement containing
the information required by division (C) of this section; |
| (ii) |
The person has sent the statement to the domestic insurer; |
| (iii) |
The offer, request, invitation, agreement, or acquisition has been approved by
the superintendent in the manner provided in division (F) of this
section. |
|
| (b) |
The requirements of division (B)(2)(a) of this
section shall be met at the time any offer, request, or invitation is made, or
any agreement is entered into, or prior to the acquisition of the securities if
no offer or agreement is involved. |
|
| (3) |
Any controlling person of a domestic insurer seeking
to divest its controlling interest in the domestic insurer shall file a
confidential notice of its proposed divestiture with the superintendent at
least thirty days prior to the cessation of control, and provide a copy of the
confidential notice to the insurer. The superintendent may require the person
seeking to divest the controlling interest to file for and obtain approval of
the transaction. The information shall remain confidential until the conclusion
of the transaction unless the superintendent, in the superintendent's
discretion, determines that the confidential treatment will interfere with
enforcement of this section. If the statement required by division (B)(2) of
this section is otherwise filed with the superintendent in relation to all
parties that acquire a controlling interest as a result of the divestiture,
this division shall not apply. |
|
| (C) |
The statement required by division (B)(2) of this section shall be made under
oath or affirmation, and shall contain all of the following information:
| (1) |
The
name and address of each acquiring party; |
| (2) |
If
the acquiring party is an individual, the individual's principal occupation and
all offices and positions held during the past five years, and any conviction
of crimes other than minor traffic violations during the past ten
years; |
| (3) |
If the
acquiring party is not an individual, a report of the nature of its business
operations during the past five years or for such lesser period as the
acquiring party and any of its predecessors shall have been in existence; an
informative description of the business intended to be done by the acquiring
party and the acquiring party's subsidiaries; and a list of all individuals who
are or who have been selected to become directors or executive officers of the
acquiring party, who perform or will perform functions appropriate to such
positions. The list shall include for each individual the information required
by division (C)(2) of this section. |
| (4) |
The
source, nature, and amount of the consideration used or to be used in effecting
the merger or other acquisition of control, a description of any transaction in
which funds were or are to be obtained for any such purpose, including any
pledge of the domestic insurer's stock, or the stock of any of its subsidiaries
or controlling affiliates, and the identity of persons furnishing such
consideration; |
| (5) |
Fully
audited financial information as to the earnings and financial condition of
each acquiring party for its preceding five fiscal years, or for such lesser
period as the acquiring party and any of its predecessors shall have been in
existence, and similar unaudited information as of a date not earlier than
ninety days prior to the filing of the statement; |
| (6) |
Any
plans or proposals which each acquiring party may have to liquidate such
domestic insurer, to sell its assets or merge or consolidate it with any
person, or to make any other material change in its business or corporate
structure or management; |
| (7) |
The
number of shares of any security of such issuer or such controlling person that
each acquiring party proposes to acquire, and the terms of the offer, request,
invitation, agreement, or acquisition, and a statement as to the method by
which the fairness of the proposal was determined; |
| (8) |
The
amount of each class of any security of such issuer or such controlling person
which is beneficially owned or concerning which there is a right to acquire
beneficial ownership by each acquiring party; |
| (9) |
A
full description of any contracts, arrangements, or understandings with respect
to any security of such issuer or such controlling person in which any
acquiring party is involved, including but not limited to transfer of any of
the securities, joint ventures, loan or option arrangements, puts or calls,
guarantees of loans, guarantees against loss or guarantees of profits, division
of losses or profits, or the giving or withholding of proxies. The description
shall identify the persons with whom such contracts, arrangements, or
understandings have been made. |
| (10) |
A
description of the purchase of any security of such issuer or such controlling
person during the year preceding the filing of the statement, by any acquiring
party, including the dates of purchase, names of the purchasers, and
consideration paid or agreed to be paid therefor; |
| (11) |
A
description of any recommendations to purchase any security of such issuer or
such controlling person made during the year preceding the filing of the
statement, by any acquiring party, or by anyone based upon interviews or at the
suggestion of the acquiring party; |
| (12) |
Copies of all tender offers for, requests, or invitations for tenders of,
exchange offers for, and agreements to acquire or exchange any securities of
such issuer or such controlling person, and, if distributed, of additional
solicitation material relating thereto; |
| (13) |
The terms of any agreement, contract, or understanding made with or proposed to
be made with any broker or dealer as to solicitation of securities of such
issuer or such controlling person for tender, and the amount of any fees,
commissions, or other compensation to be paid to brokers or dealers with regard
thereto; |
| (14) |
With
respect to proposed affiliations between depository institutions or any
affiliate thereof, within the meaning of Title I, section 104(c) of the
"Gramm-Leach-Bliley Act," Pub. L. No. 106-102, 113 Stat. 1338 (1999), and a
domestic insurer, the proposed effective date of the acquisition or change of
control; |
| (15) |
An agreement by the person required to file the statement
required by division (B) of this section that the person will provide the
annual registration required by division (K) of section 3901.33 of the Revised
Code for so long as the person has control of the domestic
insurer; |
| (16) |
An acknowledgment by the person required to file the
statement required by division (B) of this section that the person and all
subsidiaries within the person's control in the insurance holding company
system will provide information to the superintendent upon request as necessary
to evaluate enterprise risk to the insurer; |
| (17) |
Such additional information as the superintendent may by rule prescribe as
necessary or appropriate for the protection of policyholders of the domestic
insurer or in the public interest. |
|
| (D) |
| (1) |
If
the person required to file the statement required by division (B)(2) of this
section is a partnership, limited partnership, syndicate, or other group, the
superintendent may require that the information required by division (C) of
this section be furnished with respect to each partner of such partnership or
limited partnership, each member of such syndicate or group, and each person
that controls such partner or member. If any such partner, member, or person is
a corporation, or the person required to file the statement is a corporation,
the superintendent may require that the information required by division (C) of
this section be furnished with respect to the corporation, each officer and
director of the corporation, and each person that is directly or indirectly the
beneficial owner of more than ten per cent of the outstanding voting securities
of the corporation. |
| (2) |
If any material change occurs in the facts set
forth in the statement required by division (B)(2) of this section, an
amendment setting forth such change, together with copies of all documents and
other material relevant to the change, shall be filed with the superintendent
by the person subject to division (B)(2) of this section and sent to the
domestic insurer within two business days after such person learns of the
occurrence of the material change. |
|
| (E) |
If
any offer, request, invitation, agreement, or acquisition described in division
(B)(1) of this section is proposed to be made by means of a registration
statement under the "Securities Act of 1933," 48 Stat. 74, 15 U.S.C.A. 78a, or
in circumstances requiring the disclosure of similar information under the
"Securities Exchange Act of 1934," 48 Stat. 881, 15 U.S.C.A. 78a, or under a
state law requiring similar registration or disclosure, the person required to
file the statement required by division (B)(2) of this section may use such
documents in furnishing the information required by that statement. |
| (F) |
| (1) |
The superintendent shall approve any merger or other acquisition of control
described in division (B)(1) of this section unless, after a public hearing,
the superintendent finds that any of the following apply:
| (a) |
After the change of control, the domestic insurer would not be able to satisfy
the requirements for the issuance of a license to write the line or lines of
insurance for which it is presently licensed; |
| (b) |
The
effect of the merger or other acquisition of control would be substantially to
lessen competition in insurance in this state or tend to create a
monopoly; |
| (c) |
The
financial condition of any acquiring party is such as might jeopardize the
financial stability of the domestic insurer, or prejudice the interests of its
policyholders; |
| (d) |
The plans or
proposals that the acquiring party has to liquidate the domestic insurer, sell
its assets, or consolidate or merge it with any person, or to make any other
material change in its business or corporate structure or management, are
unfair and unreasonable to policyholders of the domestic insurer and not in the
public interest; |
| (e) |
The
competence, experience, and integrity of those persons that would control the
operation of the domestic insurer are such that it would not be in the interest
of policyholders of the domestic insurer and of the public to permit the merger
or other acquisition of control; |
| (f) |
The
acquisition is likely to be hazardous or prejudicial to the insurance-buying
public. |
|
| (2) |
| (a) |
Chapter 119. of the Revised Code, except for
section 119.09 of the Revised Code, applies to any hearing held under division
(F)(1) of this section, including the notice of the hearing, the conduct of the
hearing, the orders issued pursuant to it, the review of the orders, and all
other matters relating to the holding of the hearing, but only to the extent
that Chapter 119. of the Revised Code is not inconsistent or in conflict with
this section. |
| (b) |
The notice of a hearing required under this
division shall be transmitted by personal service, certified mail, e-mail, or
any other method designed to ensure and confirm receipt of the notice, to the
persons and addresses designated to receive notices and correspondence in the
information statement filed under division (B)(2) of this section. Confirmation
of receipt of the notice, including electronic "Read Receipt" confirmation,
shall constitute evidence of compliance with the requirement of this section.
The notice of hearing shall include the reasons for the proposed action and a
statement informing the acquiring party that the party is entitled to a
hearing. The notice also shall inform the acquiring party that at the hearing
the acquiring party may appear in person, by attorney, or by such other
representative as is permitted to practice before the superintendent, or that
the acquiring party may present its position, arguments, or contentions in
writing, and that at the hearing the acquiring party may present evidence and
examine witnesses appearing for and against the acquiring party. A copy of the
notice also shall be transmitted to attorneys or other representatives of
record representing the acquiring party. |
| (c) |
The hearing shall be held at the offices of the superintendent within ten
calendar days, but not earlier than seven calendar days, of the date of
transmission of the notice of hearing by any means, unless it is postponed or
continued; but in no event shall the hearing be held unless notice is received
at least three days prior to the hearing. The superintendent may postpone or
continue the hearing upon receipt of a written request by an acquiring party,
or upon the superintendent's motion, provided, however, a hearing in connection
with a proposed change of control involving a depository institution or any
affiliate thereof, within the meaning of Title I, section 104(c) of the
"Gramm-Leach-Bliley Act," Pub. L. No. 106-102, 113 Stat. 1338 (1999), and a
domestic insurer, may be postponed or continued only upon the request of an
acquiring party, or upon the superintendent's motion when the acquiring party
agrees in writing to extend the sixty-day period provided for in section 104(c)
of the "Gramm-Leach-Bliley Act," by a number of days equal to the number of
days of such postponement or continuance. |
| (d) |
For the purpose of conducting any hearing held under this section, the
superintendent may require the attendance of such witnesses and the production
of such books, records, and papers as the superintendent desires, and may take
the depositions of witnesses residing within or without the state in the same
manner as is prescribed by law for the taking of depositions in civil actions
in the court of common pleas, and for that purpose the superintendent may, and
upon the request of an acquiring party shall, issue a subpoena for any
witnesses or a subpoena duces tecum to compel the production of any books,
records, or papers, directed to the sheriff of the county where such witness
resides or is found, which shall be served and returned in the same manner as a
subpoena in a criminal case is served and returned. The fees of the sheriff
shall be the same as that allowed in the court of common pleas in criminal
cases. Witnesses shall be paid the fees and mileage provided for under section
119.094 of the Revised Code. Fees and mileage shall be paid from the fund in
the state treasury for the use of the superintendent in the same manner as
other expenses of the superintendent are paid. In any case of disobedience or
neglect of any subpoena served on any person or the refusal of any witness to
testify in any matter regarding which the witness may lawfully be interrogated,
the court of common pleas of any county where such disobedience, neglect, or
refusal occurs or any judge thereof, on application by the superintendent,
shall compel obedience by attachment proceedings for contempt, as in the case
of disobedience of the requirements of a subpoena issued from the court or a
refusal to testify therein. In any hearing held under
this section, a record of the testimony, as provided by stenographic means or
by use of audio electronic recording devices, as determined by the
superintendent, and other evidence submitted shall be taken at the expense of
the superintendent. The record shall include all of the testimony and other
evidence, and rulings on the admissibility thereof, presented at the
hearing. The superintendent shall
pass upon the admissibility of evidence, but a party to the proceedings may at
that time object to the rulings of the superintendent, and if the
superintendent refuses to admit evidence, the party offering the evidence shall
proffer the evidence. The proffer shall be made a part of the record of the
hearing. In any hearing held under
this section, the superintendent may call any person to testify under oath as
upon cross-examination. The superintendent, or any one delegated by the
superintendent to conduct a hearing, may administer oaths or
affirmations. In any hearing under this
section, the superintendent may appoint a hearing officer to conduct the
hearing; the hearing officer has the same powers and authority in conducting
the hearing as is granted to the superintendent. The hearing officer shall have
been admitted to the practice of law in the state and be possessed of any
additional qualifications as the superintendent requires. The hearing officer
shall submit to the superintendent a written report setting forth the hearing
officer's finding of fact and conclusions of law and a recommendation of the
action to be taken by the superintendent. A copy of the written report and
recommendation shall, within seven days of the date of filing thereof, be
served upon the acquiring party or the acquiring party's attorney or other
representative of record, by personal service, certified mail,
electronic
mail, or any other method designed to ensure and confirm receipt of the
report. The acquiring party may, within three days of receipt of the copy of
the written report and recommendation, file with the superintendent written
objections to the report and recommendation, which objections the
superintendent shall consider before approving, modifying, or disapproving the
recommendation. The superintendent may grant extensions of time to the
acquiring party within which to file such objections. No recommendation of the
hearing officer shall be approved, modified, or disapproved by the
superintendent until after three days following the service of the report and
recommendation as provided in this section. The superintendent may order
additional testimony to be taken or permit the introduction of further
documentary evidence. The superintendent may approve, modify, or disapprove the
recommendation of the hearing officer, and the order of the superintendent
based on the report, recommendation, transcript of testimony, and evidence, or
the objections of the acquiring party, and additional testimony and evidence
shall have the same effect as if the hearing had been conducted by the
superintendent. No such recommendation is final until confirmed and approved by
the superintendent as indicated by the order entered in the record of
proceedings, and if the superintendent modifies or disapproves the
recommendations of the hearing officer, the reasons for the modification or
disapproval shall be included in the record of proceedings. After the order is
entered, the superintendent shall transmit in the manner and by any of the
methods set forth in division (F)(2)(b) of this section a certified copy of the
order and a statement of the time and method by which an appeal may be
perfected. A copy of the order shall be mailed to the attorneys or other
representatives of record representing the acquiring party.
|
| (e) |
An
order of disapproval issued by the superintendent may be appealed to the court
of common pleas of Franklin county by filing a notice of appeal with the
superintendent and a copy of the notice of appeal with the court, within
fifteen calendar days after the transmittal of the copy of the order of
disapproval. The notice of appeal shall set forth the order appealed from and
the grounds for appeal, in accordance with section 119.12 of the Revised
Code. |
|
| (3) |
The superintendent may retain at the acquiring
party's expense any attorneys, actuaries, accountants, and other experts not
otherwise a part of the superintendent's staff as may be reasonably necessary
to assist the superintendent in reviewing the proposed acquisition of
control. |
|
| (G) |
This section does not apply to either of the
following:
| (1) |
Any
transaction that is subject to section 3921.14, or sections 3925.27 to 3925.31, 3941.35
to 3941.46, or section 3953.19 of the Revised Code; |
| (2) |
Any
offer, request, invitation, agreement, or acquisition that the superintendent
by order exempts from this section on either of the following bases:
| (a) |
It
has not been made or entered into for the purpose and does not have the effect
of changing or influencing the control of a domestic insurer; |
| (b) |
It
is not otherwise comprehended within the purposes of this
section. |
|
|
| (H) |
Nothing in this section or in any other section of Title XXXIX of the Revised
Code shall be construed to impair the authority of the attorney general to
investigate or prosecute actions under any state or federal antitrust law with
respect to any merger or other acquisition involving domestic
insurers. |
| (I) |
In connection with a proposed change of control
involving a depository institution or any affiliate thereof, within the meaning
of Title I, section 104(c) of the "Gramm-Leach-Bliley Act," Pub. L. No.
106-102, 113 Stat. 1338 (1999), and a domestic insurer, not later than sixty
days after the date of the notification of the proposed change in control
submitted pursuant to division (B)(2) of this section, the superintendent shall
make any determination that the person acquiring control of the insurer shall
maintain or restore the capital of the insurer to the level required by the
laws and regulations of this state. |
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date:
08-06-2002; 2008 HB525 07-01-2009
| (A) |
Whenever
it appears to the superintendent of insurance that any person has committed or
is about to commit a violation of section
3901.321 of the Revised Code or of
any rule or order issued by the superintendent under that section, the
superintendent may apply to the court of common pleas of the county in which
the principal office of the domestic insurer is located, or the court of common
pleas of Franklin county if the domestic insurer has no such office in this
state, for either or both of the following:
| (1) |
An order enjoining the person from
violating or continuing to violate section
3901.321 of the Revised Code or
any such rule or order; |
| (2) |
Other
equitable relief as the nature of the case and the interests of the public or
the domestic insurer's policyholders, creditors, and shareholders may require.
|
|
| (B) |
| (1) |
No security that is the subject of any agreement
or arrangement regarding acquisition, or which is acquired or to be acquired,
in contravention of section
3901.321 of the Revised Code or of
any rule or order issued by the superintendent under that section may be voted
at any shareholder's meeting, or counted for quorum purposes. Any action of
shareholders requiring the affirmative vote of a percentage of shares may be
taken as though such securities were not issued and outstanding. No action
taken at any such meeting shall be invalidated by the voting of such
securities, unless the action would materially affect control of the domestic
insurer, or unless the courts of this state have so ordered. |
| (2) |
If a domestic insurer or the
superintendent has reason to believe that any security of the domestic insurer
has been or is about to be acquired in contravention of section
3901.321 of the Revised Code or of
any rule or order issued by the superintendent under that section, the domestic
insurer or the superintendent may apply to the court of common pleas of the
county in which the domestic insurer has its principal place of business, or
the court of common pleas of Franklin county if the domestic insurer's
principal place of business is not in this state, for any or all of the
following:
| (a) |
An order enjoining any offer,
request, invitation, agreement, or acquisition made in contravention of section
3901.321 of the Revised Code or
any rule or order issued by the superintendent under that section; |
| (b) |
An order enjoining the voting of any
security so acquired; |
| (c) |
An order
voiding any vote of such security already cast at any meeting of shareholders;
|
| (d) |
Such other equitable relief as
the nature of the case and the interests of the public or the domestic
insurer's policyholders, creditors, and shareholders may require.
|
|
|
| (C) |
In any
case where a person has acquired or is proposing to acquire any voting
securities in violation of section
3901.321 of the Revised Code or
any rule or order issued by the superintendent under that section, the court of
common pleas of Franklin county or the court of common pleas of the county in
which the domestic insurer has its principal place of business may, upon the
application of the domestic insurer or the superintendent and such notice as
the court finds appropriate, seize or sequester any voting securities of the
domestic insurer owned directly or indirectly by such person, and issue an
order with respect thereto as may be appropriate to effectuate the purposes of
section 3901.321 of the Revised Code.
|
| (D) |
Notwithstanding any other
provisions of law, for the purposes of sections
3901.321 to
3901.323 of the Revised Code, the
situs of the ownership of the securities of domestic insurers is deemed to be
in this state. |
Effective Date:
03-17-1989 .
| (A) |
The courts
of this state have personal jurisdiction over both of the following:
| (1) |
Every person that is not a resident or
domiciliary of, nor authorized to do business in, this state, and that files a
statement with the superintendent of insurance under section
3901.321 of the Revised Code;
|
| (2) |
All actions involving such
person arising out of violations of section
3901.321 of the Revised Code.
|
|
| (B) |
Each person
described in division (A) of this section is deemed to have performed acts
equivalent to and constituting an appointment of the superintendent to be his
attorney upon whom may be served all process in any action, suit, or proceeding
arising out of violations of section
3901.321 of the Revised Code.
Copies of all such process shall be served on the superintendent and
transmitted by certified mail by the superintendent to such person at his last
known address. |
Effective Date:
03-17-1989 .
| (A) |
Every insurer that is authorized to do business in
this state and that is a member of an insurance holding company system shall
register with the superintendent of insurance, except a foreign insurer subject
to disclosure requirements and standards adopted by statute or regulation in
the jurisdiction of its domicile that are substantially similar to those
contained in this section and section 3901.341 of the Revised Code. Every
insurer that is subject to registration under this section shall register
initially not later than thirty days after it becomes subject to registration,
unless the
superintendent for good cause shown extends the time for registration, and then
within the extended time, and every such insurer shall register annually after
its initial registration. The superintendent may require any authorized insurer
that is a member of a holding company system that is not subject to
registration under this section to furnish a copy of the registration statement
or other information filed by the insurance company with the insurance
regulatory authority of domiciliary jurisdiction. |
| (B) |
Every insurer subject to registration shall file a registration statement
with the superintendent on a form
and in a format provided by the superintendent,
which shall contain current information about all of
the following:
| (1) |
The capital
structure, general financial condition, ownership, and management of the
insurer and any person controlling the insurer; |
| (2) |
The
identity of every member of the insurance holding company system; |
| (3) |
The
following agreements in force, relationships subsisting, and transactions
currently outstanding between the insurer and its affiliates:
| (a) |
Loans, other investments, or purchases, sales or exchanges of securities of the
affiliates by the insurer or of the insurer by its affiliates; |
| (b) |
Purchases, sales, or exchanges of assets; |
| (c) |
Transactions not in the ordinary course of business; |
| (d) |
Guarantees or undertakings for the benefit of an affiliate that result in an
actual contingent exposure of the insurer's assets to liability, other than
insurance contracts entered into in the ordinary course of the insurer's
business; |
| (e) |
All
management and service contracts and all cost-sharing arrangements; |
| (f) |
Reinsurance agreements; |
| (g) |
Dividends
and other distributions to shareholders; |
| (h) |
Consolidated tax allocation agreements. |
|
| (4) |
Any
pledge of the insurer's stock, including stock of any subsidiary or controlling
affiliate, for a loan made to any member of the insurance holding company
system; |
| (5) |
If requested by the superintendent, financial statements of
an insurance holding company system, including all affiliates. Financial
statements may include annual audited financial statements filed with the
United States securities and exchange commission pursuant to the "Securities
Act of 1933," 48 Stat. 74, 15 U.S.C. 77a, or the "Securities Exchange Act of
1934," 48 Stat. 881, 15 U.S.C. 78a. The insurer may satisfy the request by
providing the superintendent with the most recently filed parent corporation
financial statements that have been filed with the securities and exchange
commission. |
| (6) |
Other
matters concerning transactions between registered insurers and any affiliates
as may be included from time to time in any registration forms adopted or
approved by the superintendent; |
| (7) |
Statements that the insurer's or its ultimate controlling
person's board of directors oversees corporate governance and internal controls
and that the insurer's or its ultimate controlling person's officers or senior
management have approved, implemented, and continue to maintain and monitor
corporate governance and internal control procedures; |
| (8) |
Any other information required by the superintendent by
rule or regulation. |
|
| (C) |
Each registration statement filed pursuant to division (B) of this section
shall summarize the information that has changed from the prior registration
statement filed pursuant to that division. |
| (D) |
No
information need be disclosed on the registration statement filed pursuant to
division (B) of this section if the information is not material for the
purposes of this section. Unless the superintendent by rule, regulation, or
order provides otherwise, sales, purchases, exchanges, loans or extensions of
credit, or investments involving one-half of one per cent or less of an
insurer's admitted assets as of the thirty-first day of December next preceding
shall not be deemed material for the purposes of this section. |
| (E) |
Each registered insurer shall keep current the information required to be
disclosed in its registration statement by reporting all material changes or
additions on amendment forms provided by the superintendent within fifteen days
after the end of the month in which it learns of each change or
addition. |
| (F) |
The superintendent shall terminate the
registration of any insurer that demonstrates that it no longer is a member of
an insurance holding company system. |
| (G) |
The superintendent may require or allow two or more affiliated insurers subject
to registration under this section to file a consolidated registration
statement or consolidated reports amending their consolidated registration
statement or their individual registration statements. |
| (H) |
The superintendent may allow an insurer that is authorized to do business in
this state and that is part of an insurance holding company system to register
on behalf of any affiliated insurer that is required to register under division
(A) of this section and to file all information and material required to be
filed under this section. |
| (I) |
This section does not apply to any insurer, information, or transaction if and
to the extent that the superintendent by rule, regulation, or order exempts it
from this section. |
| (J) |
Any person may file with the superintendent a
disclaimer of affiliation with any authorized insurer or such a disclaimer may
be filed by the insurer or any member of an insurance holding company system.
The disclaimer shall fully disclose all material relationships and bases for
affiliation between the person and the insurer as well as the basis for
disclaiming the affiliation. After a disclaimer has been filed, the insurer
shall be relieved of any duty to register or report under this section which
may arise out of the insurer's relationship with the person unless and until
the superintendent disallows the disclaimer. The superintendent shall disallow
such a disclaimer only in the manner provided in Chapter 119. of the Revised
Code. |
| (K) |
The ultimate controlling
person of every insurer subject to registration under this section also shall
file an annual enterprise risk report. The report shall be appropriate to the
nature, scale, and complexity of the operations of the insurance holding
company system and shall, to the best of the ultimate controlling person's
knowledge and belief, identify the material risks within the insurance holding
company system that could pose enterprise risk to the insurer. The ultimate
controlling person shall file the report with the lead state commissioner of
the insurance holding company system as determined by the procedures within the
financial analysis handbook adopted by the national association of insurance
commissioners. |
| (L) |
The failure to file any registration statement or
any amendment thereto or enterprise risk report
required by this section within the time specified for the filing is a
violation of this section. |
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 03-03-1996
.
| (A) |
Transactions within an insurance holding company system to
which an insurer subject to registration is a party shall be subject to
the following standards:
| (1) |
The terms
shall be fair and reasonable. |
| (2) |
Charges or fees for services performed shall be reasonable. |
| (3) |
Expenses incurred and payment received shall be allocated to the insurer in
conformity with customary insurance accounting practices that are consistently
applied. |
| (4) |
The books,
accounts, and records of each party shall be so maintained as to clearly and
accurately disclose the precise nature and details of the transactions
including such accounting information as is necessary
to support the reasonableness of the charges or fees to the respective
parties. |
| (5) |
The
insurer's surplus as regards policyholders following any dividends or
distributions to shareholder affiliates shall be reasonable in relation to the
insurer's outstanding liabilities and adequate to its financial
needs. |
| (6) |
Agreements for cost-sharing services and management
services shall include such provisions as required by the superintendent of
insurance in rule or regulation. |
|
| (B) |
For the purposes of this section, in determining whether an insurer's surplus
as regards policyholders is reasonable in relation to the insurer's outstanding
liabilities and adequate to its financial needs, the following factors, among
others, may be considered:
| (1) |
The size of
the insurer as measured by its assets, capital, surplus, reserves, premium
writings, insurance in force, and other appropriate criteria; |
| (2) |
The
extent to which the insurer's business is diversified among the several lines
of insurance; |
| (3) |
The number
and size of risks insured in each line of business; |
| (4) |
The
extent of the geographical dispersion of the insurer's insured risks; |
| (5) |
The
nature and extent of the insurer's reinsurance program; |
| (6) |
The
quality, diversification, and liquidity of the insurer's investment
portfolio; |
| (7) |
The recent
past and projected future trend in the size of the insurer's surplus as regards
policyholders; |
| (8) |
The adequacy
of the insurer's reserves; |
| (9) |
The
quality and liquidity of investments in subsidiaries. The superintendent may
discount any such investment or treat any investment as a nonadmitted asset for
purposes of determining the adequacy of surplus as regards policyholders
whenever the investment so warrants. |
| (10) |
The quality of the insurer's earnings and the extent to which the reported
earnings include extraordinary items; |
| (11) |
The surplus as regards policyholders maintained by other comparable insurers in
respect of the factors enumerated in this division. |
|
| (C) |
No
insurer subject to registration under section 3901.33 of the Revised Code shall
pay any extraordinary dividend or make any other extraordinary distribution to
its shareholders and the declaration of any such dividend or distribution shall
be conditional and shall confer no rights upon shareholders until thirty days
after the superintendent has received notice of the declaration thereof and has
not within the thirty-day period disapproved the dividend or distribution, or
the superintendent has approved the dividend or distribution within the
thirty-day period. Prior to paying any
dividend or distribution, the insurer shall notify the superintendent on a form
provided by the superintendent for informational purposes within five business
days following its declaration of any dividend or distribution and at least ten
calendar days prior to payment of such dividend or distribution, such
ten-calendar-day period to be measured from the date of the superintendent's
receipt of the notice. For the purposes of this
section, an extraordinary dividend or distribution includes any dividend or
distribution of cash or other property, whose fair market value, together with
that of other dividends or distributions made within the preceding twelve
months, exceeds the greater of ten per cent of the insurer's surplus as regards
policyholders as of the thirty-first day of December next preceding, or the net
income of the insurer for the twelve-month period ending the thirty-first day
of December next preceding, but shall not include pro rata distributions of any
class of the insurer's own securities. Any dividend or
distribution paid from other than earned surplus shall be considered an
extraordinary dividend or extraordinary distribution. For the purposes of this
section, "earned surplus" means an amount equal to an insurer's unassigned
funds as set forth in its most recent statutory financial statement submitted
to the superintendent, including net unrealized capital gains and losses or
revaluation of assets.
|
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 03-03-1996
.
| (A) |
No insurer subject to registration under section
3901.33 of the Revised Code shall enter into any of the following transactions
with any person in its insurance holding company system, including amendments or modifications of affiliate
agreements previously filed under this section that are subject to the
materiality standards contained in divisions (A)(1) to (5) of this
section, until thirty days after the superintendent of insurance has
received, for the superintendent's review, written notice of the
insurer's intention to enter into the transaction and if, during that period,
the superintendent has not disapproved the proposed transaction.
The notice for amendments or modifications shall include the reasons for the
change and the financial impact on the domestic insurer. Informal notice shall
be reported to the superintendent within thirty days after termination of a
previously filed agreement. These requirements shall apply to all of the
following transactions:
| (1) |
Any sale,
purchase, exchange of assets, loan, extension of credit, guarantee, or
investment, if the transaction equals or exceeds, with respect to insurers
other than life insurers, the lesser of three per cent of the insurer's
admitted assets as of the thirty-first day of December next preceding or
twenty-five per cent of the insurer's surplus as regards policyholders as of
the thirty-first day of December next preceding or, with respect to life
insurers, three per cent of the insurer's admitted assets as of the
thirty-first day of December next preceding; |
| (2) |
Any
loan or extension of credit to any person that is not an affiliate of the
insurer, if both of the following apply:
| (a) |
The
loan or extension of credit equals or exceeds, with respect to insurers other
than life insurers, the lesser of three per cent of the insurer's admitted
assets as of the thirty-first day of December next preceding or twenty-five per
cent of the insurer's surplus as regards policyholders as of the thirty-first
day of December next preceding or, with respect to life insurers, three per
cent of the insurer's admitted assets as of the thirty-first day of December
next preceding. |
| (b) |
The insurer
makes the loan or extends the credit with an agreement or understanding that
the proceeds of the transaction, in whole or in substantial part, are to be
used to make loans or extend credit to, to purchase assets of, or to make
investments in, any affiliate of the insurer. |
|
| (3) |
Reinsurance agreements or modifications including all of the
following:
| (a) |
All new reinsurance pooling agreements; |
| (b) |
All reinsurance pooling agreements in which a domestic
company is newly added; |
| (c) |
Agreements in which the reinsurance premium or the
change in the insurer's liabilities, or the projected
reinsurance premium or a change in the insurer's liabilities in any of the next
three years, equals or exceeds five per cent of the insurer's surplus as
regards policyholders as of the thirty-first day of December next preceding. Division (A)(3) of this section also applies to
reinsurance agreements that may require as consideration the transfer of assets
from an insurer to a nonaffiliate, if the insurer and nonaffiliate have an
agreement or understanding that any portion of the assets will be transferred
to one or more affiliates of the insurer.
|
|
| (4) |
All
management agreements, service contracts, tax
allocations agreements, and cost-sharing arrangements; |
| (5) |
Any
other material transaction that the superintendent, pursuant to rules adopted
in accordance with Chapter 119. of the Revised Code, determines may render the
insurer's surplus as regards policyholders unreasonable in relation to the
insurer's outstanding liabilities and inadequate to its financial
needs. |
|
| (B) |
In reviewing transactions under division (A) of
this section, the superintendent shall consider whether the terms of the
transaction are fair and reasonable and whether the transaction may adversely
affect the interests of policyholders. |
| (C) |
Any transaction or agreement described in division (A) of this section that is
not disapproved by the superintendent in accordance with that division is
effective as of the effective date set forth in the notice required under this
section. |
| (D) |
The superintendent, pursuant to rules adopted in
accordance with Chapter 119. of the Revised Code, may designate certain types
of transactions that need not be submitted for review under division (A) of
this section, if those transactions would not have a significant impact on the
financial condition of an insurer. |
| (E) |
A
domestic insurer shall not enter into any transaction described in division (A)
of this section with members of its insurance holding company system if the
transaction is part of a plan or series of similar transactions and if the
purpose of entering into the separate transactions is to avoid the review
required under division (A) of this section that would otherwise occur. If the
superintendent determines that the insurer, within a twelve-month period,
entered into those separate transactions for that purpose,
the
superintendent may take any action authorized by section 3901.37 of the
Revised Code. |
| (F) |
A domestic insurer shall give written notice to
the superintendent, within thirty days after making an investment, if the
investment is made in a corporation and the total investment in the corporation
by the insurance holding company system exceeds ten per cent of the voting
securities of the corporation. |
| (G) |
Nothing in division (A) of this section shall be construed to authorize or
permit any transaction that would otherwise be contrary to law. |
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 08-08-1991
.
| (A) |
| (1) |
In addition to the powers
that
the superintendent has under sections 3901.01 to 3901.31 of the Revised Code, relating to the
examination of insurers, the superintendent of insurance, subject to sections
119.01 to 119.13 of the
Revised Code, shall also have the power to examine any
insurer registered under section 3901.33 of the Revised Code
and its affiliates to ascertain the financial condition
of the insurer, including the enterprise risk to the insurer by the ultimate
controlling party, or by any entity or combination of entities within the
insurance holding company system, or by the insurance holding company system on
a consolidated basis. |
| (2) |
The superintendent of insurance may order any insurer
registered under section 3901.33 of the Revised Code to produce
such records, books, or
other information papers in the possession of the insurer and its affiliates as
may be reasonably necessary to
determine compliance with sections 3901.32 to 3901.37 of the
Revised Code. |
| (3) |
To determine compliance
with sections 3901.32 to 3901.37 of the Revised Code, the superintendent may
order any insurer registered under section 3901.33 of the Revised Code to
produce information not in the possession of the insurer if the insurer can
obtain access to such information pursuant to a contractual relationship,
statutory obligation, or other method. If the insurer cannot obtain the
information requested by the superintendent, the insurer shall provide the
superintendent a detailed explanation of the reason that the insurer cannot
obtain the information and the identity of the holder of information. Whenever
it appears to the superintendent that the detailed explanation is without
merit, the superintendent may require, after notice and hearing, that the
insurer pay a penalty of up to five hundred dollars per day, or the
superintendent may suspend or revoke the insurer's license. |
|
| (B) |
The superintendent may retain at the registered
insurer's expense such attorneys, actuaries, accountants, and other experts not
otherwise a part of the superintendent's staff as shall be reasonably necessary
to assist in the conduct of the examination under division (A) of this section.
Any persons so retained shall be under the direction and control of the
superintendent and shall act in a purely advisory capacity. |
| (C) |
Each registered insurer producing for examination records, books, and papers
pursuant to division (A) of this section shall be liable for and shall pay the
expense of such examination in accordance with section 3901.07 of the Revised
Code. |
| (D) |
If the insurer fails to
comply with an order issued pursuant to this section, the superintendent may
examine the affiliates to obtain the information. The superintendent also may
issue subpoenas, administer oaths, and examine under oath any person for
purposes of determining compliance with this section. Upon the failure or
refusal of any person to obey a subpoena, the superintendent may petition the
court of common pleas of Franklin county for an order compelling the witness to
appear and testify or produce documentary evidence. Failure to obey the court
order shall be punishable as contempt of court. A person who receives a
subpoena issued pursuant to this division shall appear as a witness at the
place specified in the subpoena within the state. The person is entitled to the
same fees and mileage as a witness in a civil action in the court of common
pleas. Any fees, mileage, or actual expenses necessarily incurred in securing
the attendance of a witness and their testimony shall be itemized and charged
against the insurer being examined. |
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 09-21-1971
.
| (A) |
With respect to any
insurer registered under section 3901.33 of the Revised Code and in accordance
with division (C) of this section, the superintendent of insurance may
participate in a supervisory college for any domestic insurer that is part of
an insurance holding company system with international operations in order to
determine compliance by the insurer with sections 3901.32 to 3901.37 of the
Revised Code. In participating, the superintendent may do all of the
following:
| (1) |
Initiate the
establishment of a supervisory college; |
| (2) |
Clarify the membership and participation of other
supervisors in the supervisory college; |
| (3) |
Clarify the functions of the supervisory college and
the role of other regulators, including the establishment of a group-wide
supervisor; |
| (4) |
Coordinate the ongoing
activities of the supervisory college, including planning meetings, supervisory
activities, and processes for information sharing; |
| (5) |
Establish a crisis management plan. |
|
| (B) |
Each registered insurer
subject to this section shall be liable for and shall pay the reasonable
expenses of the superintendent's participation in a supervisory college in
accordance with division (C) of this section, including reasonable travel
expenses. The superintendent may establish a regular assessment to the insurer
for the payment of these expenses. A supervisory college may be convened as
either a temporary or permanent forum for communication and cooperation between
the regulators charged with the supervision of the insurer or its
affiliates. |
| (C) |
In order to assess the
business strategy, financial position, legal and regulatory position, risk
exposure, risk management, and governance processes, and as part of the
examination of individual insurers in accordance with section 3901.35 of the
Revised Code, the superintendent may participate in a supervisory college with
other regulators charged with supervision of the insurer or its affiliates,
including other state, federal, and international regulatory agencies. The
superintendent may enter into agreements in accordance with section 3901.36 of
the Revised Code that provide the basis for cooperation between the
superintendent and the other regulatory agencies, and the activities of the
supervisory college. |
| (D) |
Nothing in this section shall delegate to the
supervisory college the authority of the superintendent to regulate or
supervise the insurer or its affiliates within its jurisdiction. |
| (E) |
As used in this section,
"supervisory college" means a forum for cooperation and communication between
the involved supervisors established for the fundamental purpose of
facilitating all of the following:
| (1) |
The effectiveness of supervision of entities that
belong to an insurance group; |
| (2) |
The supervision of the insurance group as a whole on a
group-wide basis; |
| (3) |
Improving the legal entity supervision of the entities
within the insurance group. |
|
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
| (1) |
The superintendent of insurance is authorized to act
as the group-wide supervisor for any internationally active insurance group in
accordance with this section. However, the superintendent may otherwise
acknowledge a regulatory official from another jurisdiction as the group-wide
supervisor for an internationally active insurance group, if the group meets
any of the following conditions:
| (a) |
Does not have substantial insurance operations in the
United States; |
| (b) |
Has substantial operations in the United States, but
not in this state; |
| (c) |
Has substantial insurance operations in the United
States and this state, but the superintendent has determined pursuant to the
factors set forth in divisions (B) and (F) of this section that the other
regulatory official is the appropriate group-wide supervisor. |
|
| (2) |
An insurance holding company system that does not
otherwise qualify as an internationally active insurance group may request that
the superintendent make a determination or acknowledgment as to a group-wide
supervisor for the insurance holding company system pursuant to this
section. |
|
| (B) |
| (1) |
In cooperation with other state, federal, and
international regulatory agencies, the superintendent shall identify one
group-wide supervisor for each internationally active insurance group. The
superintendent may determine that the superintendent is the appropriate
group-wide supervisor for an internationally active insurance group that
conducts substantial insurance operations concentrated in this state. However,
the superintendent may acknowledge that a regulatory official from another
jurisdiction is the appropriate group-wide supervisor for the internationally
active insurance group. The superintendent shall consider the following factors
when making a determination or acknowledgment under division (B)(1) of this
section:
| (a) |
The place of domicile of the insurers within the
internationally active insurance group that hold the largest share of the
group's written premiums, assets, or liabilities; |
| (b) |
The place of domicile of the top-tiered insurer in the
internationally active insurance group's insurance holding company
system; |
| (c) |
The location of the executive offices or largest
operational offices of the internationally active insurance
group; |
| (d) |
For the purposes of division (C)(1) of this section,
whether another regulatory official is acting or is seeking to act as the
group-wide supervisor for the internationally active insurance group under a
regulatory system that the superintendent determines to be either of the
following:
| (i) |
Substantially similar to the regulatory system under
the laws of this state; |
| (ii) |
Otherwise sufficient in terms of providing for
group-wide supervision, enterprise risk analysis, and cooperation with other
regulatory officials. |
|
| (e) |
Whether another regulatory official acting, or seeking
to act, as the group-wide supervisor for the internationally active insurance
group provides the superintendent with reasonably reciprocal recognition and
cooperation. |
|
| (2) |
If the superintendent is identified in division (B)(1)
of this section as the group-wide supervisor of an internationally active
insurance group, the superintendent may determine that it is appropriate to
acknowledge another supervisor to serve as the group-wide supervisor. The
acknowledgment of the new group-wide supervisor shall be made in accordance
with all of the following:
| (a) |
After consideration of the factors listed in division
(B)(1) of this section; |
| (b) |
In cooperation with and subject to the acknowledgment
of other regulatory officials involved with supervision of members of the
internationally active insurance group; |
| (c) |
In consultation with the internationally active
insurance group. |
|
|
| (C) |
| (1) |
Notwithstanding any other provision of law, when
another regulatory official is acting as the group-wide supervisor of an
internationally active insurance group, the superintendent shall acknowledge
that regulatory official as the group-wide supervisor. |
| (2) |
The superintendent shall make a determination or
acknowledgment under division (B) of this section as to the appropriate
group-wide supervisor for an internationally active insurance group if a
material change in the internationally active insurance group results in either
of the following:
| (a) |
The internationally active insurance group's insurers
domiciled in this state holding the largest share of the group's premiums,
assets, or liabilities; |
| (b) |
This state being the place of domicile of the
top-tiered insurer in the internationally active insurance group's insurance
holding company system. |
|
|
| (D) |
| (1) |
Pursuant to section
3901.35 of the Revised Code, the
superintendent may collect from any insurer registered under section
3901.33 of the Revised Code all
information necessary to determine whether the superintendent may act as the
group-wide supervisor of an internationally active insurance group or if the
superintendent may acknowledge another regulatory official to act as the
group-wide supervisor. |
| (2) |
Prior to issuing a determination that an
internationally active insurance group is subject to group-wide supervision by
the superintendent, the superintendent shall notify the insurer registered
under section 3901.33 of the Revised Code and
the ultimate controlling person within the internationally active insurance
group. The superintendent shall give the internationally active insurance group
not less than thirty days to provide the superintendent with additional
information pertinent to the pending determination. |
| (3) |
The superintendent shall publish on its internet web
site the identity of internationally active insurance groups that the
superintendent has determined are subject to group-wide supervision by the
superintendent. |
|
| (E) |
If the superintendent is the group-wide supervisor for
an internationally active insurance group, the superintendent may engage in any
of the following activities:
| (1) |
Assess the enterprise risks within the internationally
active insurance group to ensure all of the following:
| (a) |
That the material financial condition and liquidity
risks to members of the internationally active insurance group that are engaged
in the business of insurance are identified by management; |
| (b) |
That reasonable and effective mitigation measures are
in place. |
|
| (2) |
Request from any member of an internationally active
insurance group subject to the superintendent's supervision information
necessary and appropriate to assess enterprise risk, including information
about the members of the internationally active insurance group regarding all
of the following:
| (a) |
Governance, risk assessment, and
management; |
| (c) |
Material intercompany transactions. |
|
| (3) |
Coordinate and, through the authority of the
regulatory officials of the jurisdictions in which members of the
internationally active insurance group are domiciled, compel development and
implementation of reasonable measures designed to ensure that the
internationally active insurance group is able to timely recognize and mitigate
enterprise risks to members of the internationally active insurance group that
are engaged in the business of insurance; |
| (4) |
Communicate with other state, federal, and
international regulatory agencies for members of the internationally active
insurance group and share relevant information, subject to the confidentiality
provisions of section
3901.36 of the Revised Code,
through a supervisory college as set forth in section
3901.351 of the Revised Code or
otherwise; |
| (5) |
Enter into agreements with or obtain documentation
from any insurer registered under section
3901.33 of the Revised Code, any
member of the internationally active insurance group, and any other state,
federal, and international regulatory agency for members of the internationally
active insurance group, that provides the basis for or otherwise clarifies the
superintendent's role as group-wide supervisor. The agreements or documentation
may include provisions for resolving disputes with other regulatory officials.
The agreements or documentation shall not serve as evidence in any proceeding
to show that any insurer or person within an insurance holding company system
not domiciled or incorporated in this state is doing business in this state or
is otherwise subject to jurisdiction in this state. |
| (6) |
Any other group-wide supervision activities consistent
with this section that the superintendent considers necessary. |
|
| (F) |
If the superintendent acknowledges that another
regulatory official from a jurisdiction that is not accredited by the national
association of insurance commissioners is the group-wide supervisor of an
internationally active insurance group, the superintendent may reasonably
cooperate, through a supervisory college as set forth in section
3901.351 of the Revised Code or
otherwise, with group-wide supervision undertaken by the group-wide supervisor
if all of the following are true:
| (1) |
The superintendent's cooperation is in compliance with
the Revised Code. |
| (2) |
The regulatory official also recognizes and cooperates
with the superintendent's activities as a group-wide supervisor for other
internationally active insurance groups, as applicable. If such recognition and
cooperation is not reasonably reciprocal, the superintendent may refuse to
recognize and cooperate with the regulatory official as group-wide
supervisor. |
|
| (G) |
The superintendent may enter into agreements with or
obtain documentation from any insurer registered under section
3901.33 of the Revised Code, any
affiliate of the insurer, and other state, federal, and international
regulatory agencies for members of the internationally active insurance group
that provides the basis for or otherwise clarifies a regulatory official's role
as group-wide supervisor of an internationally active insurance
group. |
| (H) |
An insurer registered under section
3901.33 of the Revised Code
shall be liable for and shall pay the reasonable expenses of the
superintendent's participation in the administration of this section, including
engaging attorneys, actuaries, and any other professionals and all reasonable
travel expenses. |
| (I) |
The superintendent may adopt rules in accordance with
Chapter 119. of the Revised Code as necessary to implement this
section. |
Added by
132nd General Assembly File No. TBD, SB 169, §1,
eff.
12/22/2017.
| (A) |
Documents,
materials, or other information in the possession or control of the department
of insurance that are obtained by or disclosed to the superintendent of
insurance or any other person in the course of an examination or investigation
made pursuant to section 3901.35 of the Revised Code and all information
reported pursuant to section 3901.33 of the Revised Code shall be given
confidential and privileged treatment and shall not be subject to
section 149.43 of the Revised Code, subpoena, or discovery, and shall not be admissible in
evidence in any private civil action. The superintendent
shall not make
the documents, materials, or other information public unless one of the
following applies:
| (1) |
The superintendent uses the documents, materials, or other
information in furtherance of any regulatory or legal action brought as a part
of the superintendent's official duties. |
| (2) |
The superintendent has obtained the prior written
consent of the insurer pertaining to the disclosure of
the documents , materials, or other information
of the
insurer. |
| (3) |
The
superintendent, after giving the insurer and those affiliates that are
the subject of the documents , materials, or other information notice and an
opportunity to be heard in accordance with Chapter 119. of the Revised Code,
determines that the
interests of policyholders, shareholders, or the public will be served by the
disclosure , in which case the
superintendent may make disclosures as the superintendent considers
appropriate.
|
|
| (B) |
Neither the superintendent nor any person who receives
documents, materials, or other information while acting under the authority of
the superintendent or with whom such documents, materials, or other information
are shared pursuant to this section shall be permitted or required to testify
in any private civil action concerning any confidential documents, materials,
or information subject to division (A) of this section. |
| (C) |
In order to assist in the performance of the
superintendent's duties under this section, the superintendent may do either of
the following:
| (1) |
Share documents,
materials, or other information, including the confidential and privileged
documents, materials, or other information subject to division (A) of this
section with other local, state, federal, and international regulatory
and law enforcement agencies, with the national association of
insurance commissioners and its affiliates and subsidiaries,
and with members of any supervisory college described
in section 3901.351 of the Revised Code, provided that the recipient
agrees to maintain the confidential or privileged status of the confidential or
privileged documents, materials, or other information and has verified in writing the legal authority to do
so . The
superintendent may share confidential and privileged documents, materials, or
other information reported pursuant to section 3901.33 of the Revised Code only
with superintendents of states having statutes or regulations substantially
similar to division (A) of this section and who have agreed in writing not to
disclose such information.
|
| (2) |
Receive documents, materials, or information,
including otherwise confidential and privileged documents, materials, or
information from the national association of insurance commissioners and its
affiliates and subsidiaries and from regulatory and law enforcement officials
of other foreign or domestic jurisdictions. The superintendent shall maintain
as confidential or privileged any such document, material, or information
received with notice or the understanding that it is confidential or privileged
under the laws of the jurisdiction that is the source of the document,
material, or information. |
|
| (D) |
The superintendent shall enter into written agreements
with the national association of insurance commissioners governing sharing and
use of information provided pursuant to sections 3901.32 to 3901.37 of the
Revised Code consistent with division (C) of this section. The written
agreements shall do all of the following:
| (1) |
Specify procedures and protocols regarding the
confidentiality and security of information shared with the national
association of insurance commissioners and its affiliates and subsidiaries
pursuant to sections 3901.32 to 3901.37 of the Revised Code, including
procedures and protocols for sharing by the national association of insurance
commissioners with other state, federal, or international regulators; |
| (2) |
Specify that ownership of
information shared with the national association of insurance commissioners and
its affiliates and subsidiaries pursuant to sections 3901.32 to 3901.37 of the
Revised Code remains with the superintendent and the national association of
insurance commissioners' use of the information is subject to the direction of
the superintendent; |
| (3) |
Require prompt notice to be given to an insurer whose
confidential information is in the possession of the national association of
insurance commissioners or its affiliates or subsidiaries and is subject to a
request or subpoena for disclosure or production; |
| (4) |
Require the national association of insurance
commissioners and its affiliates and subsidiaries to consent to intervention by
an insurer in any judicial or administrative action in which the national
association of insurance commissioners and its affiliates and subsidiaries may
be required to disclose confidential information about the insurer shared with
the national association of insurance commissioners and its affiliates and
subsidiaries pursuant to sections 3901.32 to 3901.37 of the Revised Code. |
|
| (E) |
The sharing of
information by the superintendent pursuant to sections 3901.32 to 3901.37 of
the Revised Code shall not constitute a delegation of regulatory or rule-making
authority. The superintendent is solely responsible for the administration,
execution, and enforcement of the provisions of sections 3901.32 to 3901.37 of
the Revised Code. |
| (F) |
No waiver of any applicable
privilege or claim of confidentiality in the documents
, materials,
or other information described in this section shall occur as a result of
sharing or receiving documents and information as authorized in
division (C) of this section.
|
| (G) |
Documents,
materials, or other information in the possession or control of the national
association of insurance commissioners pursuant to this section shall be given
confidential and privileged treatment and shall not be subject to section
149.43 of the Revised Code, subpoena, or discovery, and shall not be admissible
in evidence in any private civil action. |
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 06-18-2002
.
| (A) |
Whenever
it appears to the superintendent of insurance that any person has committed a
violation of section
3901.33,
3901.34,
3901.341, or
3901.35 of the Revised Code, which
makes the continued operation of an insurer contrary to the interests of
policyholders or the public, the superintendent may, subject to Chapter 119. of
the Revised Code, suspend, revoke, or refuse to renew such insurer's license or
authority to do business in this state for such period as he finds is required
for the protection of policyholders or the public. |
| (B) |
Whenever an extraordinary dividend is paid in
knowing violation of division (C) of section
3901.34 of the Revised Code, the
superintendent may, subject to Chapter 119. of the Revised Code, cause the
insurer to pay a civil forfeiture of not more than two hundred fifty thousand
dollars, to be paid to the state treasury to the credit of the department of
insurance operating fund. Each payment of an extraordinary dividend made in
violation of division (C) of section
3901.34 of the Revised Code may be
considered a separate offense. |
Effective Date:
10-01-1993 .
The purpose of sections 3901.371 to 3901.378 of the Revised Code is to provide
the requirements for maintaining a risk management framework and completing an
own risk and solvency assessment, and to provide guidance and instructions for
filing an own risk and solvency assessment summary report with the
superintendent of insurance. The requirements of these sections shall apply to
all insurers domiciled in this state unless exempt pursuant to section 3901.376
of the Revised Code.
The general assembly finds and declares that the own risk
and solvency assessment summary report will contain confidential and sensitive
information related to an insurer or insurance group's identification of risks
material and relevant to the insurer or insurance group filing the report. This
information will include proprietary and trade secret information that has the
potential for harm and competitive disadvantage to the insurer or insurance
group if the information is made public. It is the intent of the general
assembly that the own risk and solvency assessment summary report shall be a
confidential document filed with the superintendent, that the own risk and
solvency assessment summary report will be shared only as stated in sections
3901.371 to 3901.378 of the Revised Code to assist the superintendent of
insurance in the performance of the superintendent's duties, and that in no
event shall the own risk and solvency assessment summary report be subject to
public disclosure.
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
For the purposes of sections 3901.371 to 3907.378 of the Revised Code:
| (A) |
"Insurance group" means
those insurers and affiliates included within an insurance holding company
system as defined in section 3901.32 of the Revised Code. |
| (B) |
"Insurer" has the same meaning as set forth in section
3901.32 of the Revised Code. |
| (C) |
"Own risk and solvency assessment" means a
confidential internal assessment, appropriate to the nature, scale, and
complexity of an insurer or insurance group, conducted by that insurer or
insurance group of the material and relevant risks associated with the insurer
or insurance group's current business plan, and the sufficiency of capital
resources to support those risks. |
| (D) |
"Own risk and solvency assessment guidance manual"
means the current version of the own risk and solvency assessment guidance
manual developed and adopted by the national association of insurance
commissioners and as amended from time to time. A change in the own risk and
solvency assessment guidance manual shall be effective on the first day of
January following the calendar year in which the changes have been adopted by
the national association of insurance commissioners. |
| (E) |
"Own risk and solvency assessment summary report"
means a confidential high-level summary of an insurer or insurance group's own
risk and solvency assessment. |
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
An insurer shall maintain a risk management framework to assist the insurer
with identifying, assessing, monitoring, managing, and reporting on its
material and relevant risks. This requirement may be satisfied if the insurance
group of which the insurer is a member maintains a risk management framework
applicable to the operations of the insurer.
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Unless exempted by section 3901.376 of the Revised Code, an insurer, or the
insurance group of which the insurer is a member, shall regularly conduct an
own risk and solvency assessment consistent with a process comparable to the
own risk and solvency assessment guidance manual. The own risk and solvency
assessment shall be conducted not less than annually, but also at any time when
there are significant changes to the risk profile of the insurer or the
insurance group of which the insurer is a member.
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
| (1) |
Upon the request of the
superintendent of insurance, and not more than once annually, an insurer shall
submit to the superintendent an own risk and solvency assessment summary
report, or any combination of reports that together contain the information
described in the own risk and solvency assessment guidance manual, applicable
to the insurer or the insurance group of which it is a member. |
| (2) |
Notwithstanding any request from the superintendent,
if the insurer is a member of an insurance group, the insurer shall submit the
report required by division (A)(1) of this section if the superintendent is the
lead state commissioner of the insurance group as determined by the procedures
within the financial analysis handbook adopted by the national association of
insurance commissioners. |
|
| (B) |
The report shall include a signature of the insurer or
insurance group's chief risk officer, or other executive having responsibility
for the oversight of the insurer's enterprise risk management process,
attesting to the best of the officer's or executive's belief and knowledge that
the insurer applies the enterprise risk management process described in the own
risk and solvency assessment summary report, and that a copy of the report has
been provided to the insurer's board of directors or the appropriate committee
thereof. |
| (C) |
An insurer may comply
with division (A) of this section by providing the most recent and
substantially similar report provided by the insurer or another member of an
insurance group of which the insurer is a member to the commissioner of another
state or to a supervisor or regulator of a foreign jurisdiction, if that report
provides information that is comparable to the information described in the own
risk and solvency assessment guidance manual. Any such report in a language
other than English must be accompanied by a translation of that report into the
English language. |
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
| (1) |
An insurer shall be
exempt from the requirements of sections 3901.371 to 3901.378 of the Revised
Code if both of the following apply:
| (a) |
The insurer has annual direct written and unaffiliated
assumed premium, including international direct and assumed premium, less than
five hundred million dollars. |
| (b) |
The insurance group of which the insurer is a member
has annual direct written and unaffiliated assumed premium, including
international direct and assumed premium, less than one billion dollars. |
|
| (2) |
The annual direct written
and unaffiliated assumed premium described in divisions (A)(1)(a) and (b) of
this section does not include premiums reinsured with the federal crop
insurance corporation and federal flood program. |
|
| (B) |
If an insurer qualifies for exemption pursuant to
division (A)(1)(a) of this section, but the insurance group of which the
insurer is a member does not qualify for exemption pursuant to division
(A)(1)(b) of this section, and if an own risk and solvency assessment summary
report is required pursuant to division (E) of this section, then the summary
report shall include every insurer within the insurance group. This requirement
may be satisfied if the insurer submits more than one own risk and solvency
assessment summary report for any combination of insurers provided the
combination of reports includes every insurer within the insurance group. |
| (C) |
If an insurer does not
qualify for exemption pursuant to division (A)(1)(a) of this section, but the
insurance group of which it is a member qualifies for exemption pursuant to
division (A)(1)(b) of this section, then the insurer shall only file an own
risk and solvency assessment summary report if required pursuant to division
(E) of this section. |
| (D) |
| (1) |
An insurer that does not qualify for exemption
pursuant to division (A) of this section may apply to the superintendent of
insurance for a waiver from the requirements of sections 3901.371 to 3901.378
of the Revised Code based upon unique circumstances. In deciding whether to
grant the insurer's request for waiver, the superintendent may consider any of
the following:
| (a) |
The type and volume of
business written; |
| (b) |
The ownership and organizational structure of the
insurer or insurance group of which the insurer is a member; |
| (c) |
Any other factor the superintendent considers relevant
to the insurer or insurance group of which the insurer is a member. |
|
| (2) |
If the insurer is part of
an insurance group with insurers domiciled in more than one state, the
superintendent shall coordinate with the lead state commissioner and with the
other domiciliary commissioners in considering whether to grant the insurer's
request for a waiver. |
|
| (E) |
Notwithstanding the exemptions stated in this section,
the superintendent may require that an insurer maintain a risk management
framework, conduct an own risk and solvency assessment, and file an own risk
and solvency assessment summary report in any of the following
circumstances:
| (1) |
Based on unique
circumstances, including the type and volume of business written and the
ownership and organizational structure of the insurer or insurance group of
which the insurer is a member; |
| (2) |
At the request of a federal agency; |
| (3) |
At the request of an international supervisor; |
| (4) |
If the insurer has
risk-based capital for a company action level event as set forth in section
3903.83 of the Revised Code, meets one or more of the standards set out in
section 3903.09 or 3903.71 of the Revised Code, or otherwise exhibits qualities
of a troubled insurer as determined by the superintendent. |
|
| (F) |
If an insurer that
qualifies for an exemption pursuant to division (A) of this section
subsequently no longer qualifies for that exemption due to changes in premium
as reflected in the insurer's most recent annual statement, or in the most
recent annual statements of the insurers within the insurance group of which
the insurer is a member, the insurer shall have one year after the year the
threshold is exceeded to comply with the requirements of sections 3901.371 to
3901.378 of the Revised Code. |
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
The own risk and solvency
assessment summary report shall be prepared consistent with the own risk and
solvency assessment guidance manual, subject to the requirements of division
(B) of this section, and all documentation and supporting information shall be
maintained and made available for examination upon request of the
superintendent of insurance. |
| (B) |
The superintendent's review of the own risk and
solvency assessment summary report, and any additional requests for
information, shall be made using similar procedures used in the analysis and
examination of multi-state or global insurers and insurance groups. |
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
Documents, materials, or
other information, including the own risk and solvency assessment summary
report, in the possession or control of the department of insurance that are
obtained by, created by, or disclosed to the superintendent of insurance, or
any other person under sections 3901.371 to 3901.378 of the Revised Code, are
recognized by this state as being proprietary and to contain trade
secrets. |
| (B) |
The documents described
in division (A) of this section shall be confidential by law and privileged,
and shall not be admissible into evidence in any private civil action or
subject to section 149.43 of the Revised Code, subpoena, or discovery. |
| (C) |
| (1) |
Notwithstanding division
(B) of this section, the superintendent may use the documents, materials, or
other information in furtherance of any regulatory or legal action brought as a
part of the superintendent's official duties. |
| (2) |
The superintendent shall not otherwise make the
documents, materials, or other information public without the prior written
consent of the insurer. |
|
| (D) |
Neither the superintendent nor any person who receives
documents, materials, or other own risk and solvency assessment related
information, through examination or otherwise, while acting under the authority
of the superintendent or with whom such documents, materials, or other
information are shared pursuant to sections 3901.371 to 3901.378 of the Revised
Code shall be permitted or required to testify in any private civil action
concerning any confidential documents, materials, or information subject to
division (A) of this section. |
| (E) |
| (1) |
In order to assist in the performance of the
superintendent's regulatory duties, the superintendent may do either of the
following:
| (a) |
Upon request, share
documents, materials, or other own risk and solvency assessment related
information, including confidential and privileged documents, materials, or
information subject to division (A) of this section, and proprietary and trade
secret documents, with other state, federal and international financial
regulatory agencies, members of any supervisory college as described in section
3901.351 of the Revised Code, the national association of insurance
commissioners, or any third-party consultant designated by the
superintendent; |
| (b) |
Receive documents, materials, or other own risk and
solvency assessment related information, including confidential and privileged
documents, materials, or information subject to division (A) of this section,
and proprietary and trade secret documents, from regulatory officials of other
foreign or domestic jurisdictions, including members of any supervisory college
as described in section 3901.351 of the Revised Code, and from the national
association of insurance commissioners. |
|
| (2) |
The recipient of any information pursuant to division
(E)(1)(a) of this section shall agree in writing to maintain the
confidentiality and privileged status of the documents, materials, or other
information and verify in writing their legal authority to maintain
confidentiality. If the superintendent receives any information pursuant to
division (E)(1)(b) of this section, the superintendent shall maintain as
confidential or privileged any documents, materials, or information received
with notice or the understanding that it is confidential or privileged under
the laws of the jurisdiction that is the source of the document, material, or
information. |
| (3) |
The superintendent shall
enter into a written agreement with the national association of insurance
commissioners or a third-party consultant governing sharing and use of
information provided pursuant to sections 3901.371 to 3901.378 of the Revised
Code. The written agreement shall do the all of the following:
| (a) |
Specify procedures and protocols regarding the
confidentiality and security of information shared with the national
association of insurance commissioners or a third-party consultant pursuant to
sections 3901.371 to 3901.378 of the Revised Code, including procedures and
protocols for sharing by the national association of insurance commissioners
with other state regulators from states in which the insurance group has
domiciled insurers; |
| (b) |
Provide that the recipient of information agrees in
writing to maintain the confidentiality and privileged status of the own risk
and solvency assessment related documents, materials, or other information
obtained pursuant to sections 3901.371 to 3901.378 of the Revised Code, and has
verified in writing the legal authority to maintain confidentiality; |
| (c) |
Specify that ownership of
information shared with the national association of insurance commissioners or
a third-party consultant pursuant to sections 3901.371 to 3901.378 of the
Revised Code remains with the superintendent and the national association of
insurance commissioners' or a third-party consultant's use of the information
is subject to the direction of the superintendent; |
| (d) |
Prohibit the national association of insurance
commissioners or a third-party consultant from storing the information obtained
pursuant to sections 3901.371 to 3901.378 of the Revised Code in a permanent
database after the underlying analysis is completed; |
| (e) |
Require prompt notice to be given to an insurer whose
confidential information in the possession of the national association of
insurance commissioners or a third-party consultant pursuant to sections
3901.371 to 3901.378 of the Revised Code is subject to a request or subpoena
for disclosure or production of the information; |
| (f) |
Require the national association of insurance
commissioners or a third-party consultant to consent to intervention by an
insurer in any judicial or administrative action in which the national
association of insurance commissioners or a third-party consultant may be
required to disclose confidential information about the insurer that was
obtained pursuant to sections 3901.371 to 3901.378 of the Revised Code; |
| (g) |
Require the national
association of insurance commissioners or a third-party consultant to use
documents, materials, or other information, including the own risk solvency
assessment summary report, for the specific purposes as directed by the
superintendent; |
| (h) |
Prohibit the national association of insurance
commissioners or a third-party consultant from using, sharing, or disclosing
any documents, materials, or other information, including the own risk and
solvency assessment summary report, beyond the scope of the responsibilities
outlined by the superintendent; |
| (i) |
Provide for the insurer's written consent in the case
of an agreement involving a third-party consultant. |
|
|
| (F) |
The sharing of
information, materials, and documents by the superintendent pursuant to
sections 3901.371 to 3901.378 of the Revised Code shall not constitute a
delegation of regulatory or rule-making authority, and the superintendent is
solely responsible for the administration, execution, and enforcement of
sections 3901.371 to 3901.378 of the Revised Code. |
| (G) |
No waiver of any applicable privilege or claim of
confidentiality in the documents, proprietary and trade-secret materials, or
other own risk and solvency assessment related information shall occur as a
result of disclosure of such own risk and solvency assessment related
information, materials, or documents to the superintendent as a result of
sharing authorized in sections 3901.371 to 3901.378 of the Revised Code. |
| (H) |
Documents, materials, or
other information in the possession or control of the national association of
insurance commissioners or a third-party consultant pursuant to sections
3901.371 to 3901.378 of the Revised Code shall be confidential by law and
privileged, and shall not be subject to section 149.43 of the Revised Code,
subpoena, discovery, or admissible in evidence in any private civil
action. |
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
As used in this section and sections
3901.381 to
3901.3814 of the Revised Code:
| (A) |
"Beneficiary" means any
policyholder, subscriber, member, employee, or other person who is eligible for
benefits under a benefits contract. |
| (B) |
"Benefits contract" means a sickness and accident
insurance policy providing hospital, surgical, or medical expense coverage, or
a health insuring corporation contract or other policy or agreement under which
a third-party payer agrees to reimburse for covered health care or dental
services rendered to beneficiaries, up to the limits and exclusions contained
in the benefits contract. |
| (C) |
"Hospital" has the same meaning as in section
3727.01 of the Revised Code.
|
| (D) |
"Provider" means a hospital,
nursing home, physician, podiatrist, dentist, pharmacist, chiropractor, or
other health care provider entitled to reimbursement by a third-party payer for
services rendered to a beneficiary under a benefits contract. |
| (E) |
"Reimburse" means indemnify, make
payment, or otherwise accept responsibility for payment for health care
services rendered to a beneficiary, or arrange for the provision of health care
services to a beneficiary. |
| (F) |
"Third-party payer" means any of the following:
| (1) |
An insurance company; |
| (2) |
A health insuring corporation; |
| (3) |
A labor organization; |
| (5) |
An intermediary organization, as defined
in section
1751.01 of the Revised Code, that
is not a health delivery network contracting solely with self-insured
employers; |
| (6) |
An administrator
subject to sections
3959.01 to
3959.16 of the Revised Code;
|
| (7) |
A health delivery network, as
defined in section
1751.01 of the Revised Code;
|
| (8) |
Any other person that is
obligated pursuant to a benefits contract to reimburse for covered health care
services rendered to beneficiaries under such contract. |
|
Effective Date:
07-24-2002 .
| (A) |
Except
as provided in sections
3901.382,
3901.383,
3901.384,
and
3901.386
of the Revised Code, a third-party payer shall process a claim for payment for
health care services rendered by a provider to a beneficiary in accordance with
this section. |
| (B) |
| (1) |
Unless
division (B)(2) or (3) of this section applies, when a third-party payer
receives from a provider or beneficiary a claim on the standard claim form
prescribed in rules adopted by the superintendent of insurance under section
3902.22
of the Revised Code, the third-party payer shall pay or deny the claim not
later than thirty days after receipt of the claim. When a third-party payer
denies a claim, the third-party payer shall notify the provider and the
beneficiary. The notice shall state, with specificity, why the third-party
payer denied the claim. |
| (2) |
| (a) |
Unless
division (B)(3) of this section applies, when a provider or beneficiary has
used the standard claim form, but the third-party payer determines that
reasonable supporting documentation is needed to establish the third-party
payer's responsibility to make payment, the third-party payer shall pay or deny
the claim not later than forty-five days after receipt of the claim. Supporting
documentation includes the verification of employer and beneficiary coverage
under a benefits contract, confirmation of premium payment, medical information
regarding the beneficiary and the services provided, information on the
responsibility of another third-party payer to make payment or confirmation of
the amount of payment by another third-party payer, and information that is
needed to correct material deficiencies in the claim related to a diagnosis or
treatment or the provider's identification. Not later than
thirty days after receipt of the claim, the third-party payer shall notify all
relevant external sources that the supporting documentation is needed. All such
notices shall state, with specificity, the supporting documentation needed. If
the notice was not provided in writing, the provider, beneficiary, or
third-party payer may request the third-party payer to provide the notice in
writing, and the third-party payer shall then provide the notice in writing. If
any of the supporting documentation is under the control of the beneficiary,
the beneficiary shall provide the supporting documentation to the third-party
payer. The number of days
that elapse between the third-party payer's last request for supporting
documentation within the thirty-day period and the third-party payer's receipt
of all of the supporting documentation that was requested shall not be counted
for purposes of determining the third-party payer's compliance with the time
period of not more than forty-five days for payment or denial of a claim.
Except as provided in division (B)(2)(b) of this section, if the third-party
payer requests additional supporting documentation after receiving the
initially requested documentation, the number of days that elapse between
making the request and receiving the additional supporting documentation shall
be counted for purposes of determining the third-party payer's compliance with
the time period of not more than forty-five days.
|
| (b) |
If a
third-party payer determines, after receiving initially requested
documentation, that it needs additional supporting documentation pertaining to
a beneficiary's preexisting condition, which condition was unknown to the
third-party payer and about which it was reasonable for the third-party payer
to have no knowledge at the time of its initial request for documentation, and
the third-party payer subsequently requests this additional supporting
documentation, the number of days that elapse between making the request and
receiving the additional supporting documentation shall not be counted for
purposes of determining the third-party payer's compliance with the time period
of not more than forty-five days. |
| (c) |
When a
third-party payer denies a claim, the third-party payer shall notify the
provider and the beneficiary. The notice shall state, with specificity, why the
third-party payer denied the claim. |
| (d) |
If a
third-party payer determines that supporting documentation related to medical
information is routinely necessary to process a claim for payment of a
particular health care service, the third-party payer shall establish a
description of the supporting documentation that is routinely necessary and
make the description available to providers in a readily accessible format. Third-party payers
and providers shall, in connection with a claim, use the most current CPT code
in effect, as published by the American medical association, the most current
ICD-10 code in effect, as published by the United States department of health
and human services, the most current CDT code in effect, as published by the
American dental association, or the most current HCPCS code in effect, as
published by the United States centers for medicare
and medicaid services.
|
|
| (3) |
When a
provider or beneficiary submits a claim by using the standard claim form
prescribed in the superintendent's rules, but the information provided in the
claim is materially deficient, the third-party payer shall notify the provider
or beneficiary not later than fifteen days after receipt of the claim. The
notice shall state, with specificity, the information needed to correct all
material deficiencies. Once the material deficiencies are corrected, the
third-party payer shall proceed in accordance with division (B)(1) or (2) of
this section. It is not a
violation of the notification time period of not more than fifteen days if a
third-party payer fails to notify a provider or beneficiary of material
deficiencies in the claim related to a diagnosis or treatment or the provider's
identification. A third-party payer may request the information necessary to
correct these deficiencies after the end of the notification time period.
Requests for such information shall be made as requests for supporting
documentation under division (B)(2) of this section, and payment or denial of
the claim is subject to the time periods specified in that division.
|
|
| (C) |
For
purposes of this section, if a dispute exists between a provider and a
third-party payer as to the day a claim form was received by the third-party
payer, both of the following apply:
| (1) |
If the
provider or a person acting on behalf of the provider submits a claim directly
to a third-party payer by mail and retains a record of the day the claim was
mailed, there exists a rebuttable presumption that the claim was received by
the third-party payer on the fifth business day after the day the claim was
mailed, unless it can be proven otherwise. |
| (2) |
If the
provider or a person acting on behalf of the provider submits a claim directly
to a third-party payer electronically, there exists a rebuttable presumption
that the claim was received by the third-party payer twenty-four hours after
the claim was submitted, unless it can be proven otherwise. |
|
| (D) |
Nothing
in this section requires a third-party payer to provide more than one notice to
an employer whose premium for coverage of employees under a benefits contract
has not been received by the third-party payer. |
| (E) |
Compliance with the provisions of division (B)(3) of this section shall be
determined separately from compliance with the provisions of divisions (B)(1)
and (2) of this section. |
| (F) |
A
third-party payer shall transmit electronically
any payment with respect to claims that the third-party payer receives electronically and pays to a
contracted provider under this section and under sections
3901.383,
3901.384,
and
3901.386
of the Revised Code. A provider shall not refuse to accept a payment made under
this section or sections
3901.383,
3901.384,
and
3901.386
of the Revised Code on the basis that the payment was transmitted
electronically. |
Amended by
133rd General Assembly File No. TBD, HB 166, §101.01, eff.
10/17/2019.
Amended by
131st General Assembly File No. TBD, HB 259, §1,
eff. 3/23/2016.
Amended by
131st General Assembly File No. TBD, SB 223, §1,
eff. 3/23/2016.
Amended by
128th General AssemblyFile No.9, HB 1,
§101.01, eff.
10/16/2010.
Effective Date: 07-24-2002
.
Beginning six months after the date specified in section 262 of
the "Health Insurance Portability and Accountability Act of 1996," 110 Stat.
2027, 42 U.S.C.A. 1320d-4, on which a third-party payer is
initially required to comply with a standard or implementation specification
for the electronic exchange of health information, as adopted or established by
the United States secretary of health and human services pursuant to that act,
sections 3901.381,
3901.384,
3901.385,
3901.389,
3901.3810,
3901.3811,
3901.3812, and
3901.3813 of the Revised Code
apply to a claim submitted to a third-party payer for payment for health care
services only if the claim is submitted electronically. A provider and
third-party payer may enter into a contractual arrangement under which the
third-party payer agrees to process claims that are not submitted
electronically because of the financial hardship that electronic submission of
claims would create for the provider or any other extenuating circumstance.
Effective Date:
07-24-2002 .
| (A) |
A provider
and a third-party payer may do either of the following:
| (1) |
Enter into a contractual agreement under
which time periods shorter than those set forth in section
3901.381 of the Revised Code are
applicable to the third-party payer in paying a claim for any amount due for
health care services rendered by the provider; |
| (2) |
Enter into a contractual agreement under
which the timing of payments by the third-party payer is not directly related
to the receipt of a claim form. The contractual arrangement may include
periodic interim payment arrangements, capitation payment arrangements, or
other periodic payment arrangements acceptable to the provider and the
third-party payer. Under a capitation payment arrangement, the third-party
payer shall begin paying the capitated amounts to the beneficiary's primary
care provider not later than sixty days after the date the beneficiary selects
or is assigned to the provider. Under any other contractual periodic payment
arrangement, the contractual agreement shall state, with specificity, the
timing of payments by the third-party payer. |
|
| (B) |
Regardless of whether a third-party payer is
exempted under division (D) of section
3901.3814 from sections
3901.38 and
3901.381 to
3901.3813 of the Revised Code, a
provider and the third-party payer, including a third-party payer that provides
coverage under the medicaid program, shall not enter into a contractual
arrangement under which time periods longer than those provided for in
paragraph (c)(1) of 42 C.F.R. 447.46 are applicable to the
third-party payer in paying a claim for any amount due for health care services
rendered by the provider. |
Effective Date:
07-24-2002;
03-30-2006 .
| (A) |
Subject to
division (B) of this section, a third-party payer that requires timely
submission of claims for payment for health care services shall process a claim
that is not submitted in a timely manner if a claim for the same services was
initially submitted to a different third-party payer or state or federal
program that offers health care benefits and that payer or program has
determined that it is not responsible for the cost of the health care services.
When a claim is submitted later than one year after the last date of service
for which reimbursement is sought under the claim, the third-party payer shall
pay or deny the claim not later than ninety days after receipt of the claim or,
alternatively, pursuant to the requirements of sections
3901.381 to
3901.388 of the Revised Code. The
third-party payer must make an election to process such claims either within
the ninety-day period or under section
3901.381 of the Revised Code. If
the claim is denied, the third-party payer shall notify the provider and the
beneficiary. The notice shall state, with specificity, why the third-party
payer denied the claim. |
| (B) |
The
third-party payer may refuse to process a claim submitted by a provider if the
provider submits the claim later than forty-five days after receiving notice
from the different third-party payer or a state or federal program that that
payer or program is not responsible for the cost of the health care services,
or if the provider does not submit the notice of denial from the different
third-party payer or program with the claim. The failure of a provider to
submit a notice of denial in accordance with this division shall not affect the
terms of a benefits contract. |
| (C) |
For purposes of this section, both of the following apply:
| (1) |
A determination that a third-party payer
or state or federal program is not responsible for the cost of health care
services includes a determination regarding coordination of benefits,
preexisting health conditions, ineligibility for coverage at the time services
were provided, subrogation provisions, and similar findings; |
| (2) |
State and federal programs that offer
health care benefits include medicare, medicaid, workers' compensation, the
civilian health and medical program of the uniformed services and other
elements of the tricare program offered by the United States department of
defense, and similar state or federal programs. |
|
| (D) |
Any provision of a contractual arrangement entered
into between a third-party payer and a provider or beneficiary that is contrary
to divisions (A) to (C) of this section is unenforceable. |
Effective Date:
07-24-2002 .
A third-party payer shall not do either of the following:
| (A) |
Engage in any business practice
that unfairly or unnecessarily delays the processing of a claim or the payment
of any amount due for health care services rendered by a provider to a
beneficiary; |
| (B) |
Refuse to
process or pay within the time periods specified in section
3901.381 of the Revised Code a
claim submitted by a provider on the grounds the beneficiary has not been
discharged from the hospital or the treatment has not been completed, if the
submitted claim covers services actually rendered and charges actually incurred
over at least a thirty-day period. |
Effective Date:
07-24-2002 .
| (A) |
Notwithstanding section
1751.13 or division (I)(2) of
section 3923.04 of the Revised Code, a
reimbursement contract entered into or renewed on or after June 29, 1988,
between a third-party payer and a hospital shall provide that reimbursement for
any service provided by a hospital pursuant to a reimbursement contract and
covered under a benefits contract shall be made directly to the hospital.
|
| (B) |
If the third-party payer and
the hospital have not entered into a contract regarding the provision and
reimbursement of covered services, the third-party payer shall accept and honor
a completed and validly executed assignment of benefits with a hospital by a
beneficiary, except when the third-party payer has notified the hospital in
writing of the conditions under which the third-party payer will not accept and
honor an assignment of benefits. Such notice shall be made annually. |
| (C) |
A third-party payer may not refuse to
accept and honor a validly executed assignment of benefits with a hospital
pursuant to division (B) of this section for medically necessary hospital
services provided on an emergency basis. |
Effective Date:
07-24-2002 .
| (A) |
When a
provider or beneficiary submits a duplicative claim for payment for health care
services before the time periods specified in section
3901.381 of the Revised Code have
elapsed for the original claim submitted, the third-party payer may deny the
duplicative claim. Denials of claims determined to be duplicative by the
department of insurance shall not be considered by the department in a market
conduct examination of a third-party payer's compliance with section
3901.381 of the Revised Code. The
superintendent of insurance shall have the discretion to exclude an original
claim in determining a violation under section
3901.381 of the Revised Code.
|
| (B) |
| (1) |
A third-party payer shall establish a system
whereby a provider and a beneficiary may obtain information regarding the
status of a claim for payment for health care services, provided the claim is
not materially deficient. A third-party payer shall inform providers and
beneficiaries of the mechanisms that may be used to gain access to the system.
|
| (2) |
If a third-party payer
delegates the processing of payments to another entity, the third-party payer
shall require the entity to comply with division (B)(1) of this section on
behalf of the third-party payer. |
|
Effective Date:
07-24-2002 .
| (A) |
A payment
made by a third-party payer to a provider in accordance with sections
3901.381 to
3901.386 of the Revised Code shall
be considered final two years after payment is made. After that date, the
amount of the payment is not subject to adjustment, except in the case of fraud
by the provider. |
| (B) |
A
third-party payer may recover the amount of any part of a payment that the
third-party payer determines to be an overpayment if the recovery process is
initiated not later than two years after the payment was made to the provider.
The third-party payer shall inform the provider of its determination of
overpayment by providing notice in accordance with division (C) of this
section. The third-party payer shall give the provider an opportunity to appeal
the determination. If the provider fails to respond to the notice sooner than
thirty days after the notice is made, elects not to appeal the determination,
or appeals the determination but the appeal is not upheld, the third-party
payer may initiate recovery of the overpayment. When a provider has failed to make a timely response to the
notice of the third-party payer's determination of overpayment, the third-party
payer may recover the overpayment by deducting the amount of the overpayment
from other payments the third-party payer owes the provider or by taking action
pursuant to any other remedy available under the Revised Code. When a provider
elects not to appeal a determination of overpayment or appeals the
determination but the appeal is not upheld, the third-party payer shall permit
a provider to repay the amount by making one or more direct payments to the
third-party payer or by having the amount deducted from other payments the
third-party payer owes the provider.
|
| (C) |
The notice of overpayment a third-party payer is
required to give a provider under division (B) of this section shall be made in
writing and shall specify all of the following:
| (1) |
The full name of the beneficiary who
received the health care services for which overpayment was made; |
| (2) |
The date or dates the services were
provided; |
| (3) |
The amount of the
overpayment; |
| (4) |
The claim number
or other pertinent numbers; |
| (5) |
A
detailed explanation of basis for the third-party payer's determination of
overpayment; |
| (6) |
The method in
which payment was made, including, for tracking purposes, the date of payment
and, if applicable, the check number; |
| (7) |
That the provider may appeal the
third-party payer's determination of overpayment, if the provider responds to
the notice within thirty days; |
| (8) |
The method by which recovery of the overpayment would be made, if recovery
proceeds under division (B) of this section. |
|
| (D) |
Any provision of a contractual arrangement entered
into between a third-party payer and a provider or beneficiary that is contrary
to divisions (A) to (C) of this section is unenforceable. |
Effective Date:
07-24-2002 .
| (A) |
Any
third-party payer that fails to comply with section
3901.381 of the Revised Code, or
any contractual payment arrangement entered into under section
3901.383 of the Revised Code,
shall pay interest in accordance with this section. |
| (B) |
Interest shall be computed based upon the number
of days that have elapsed between the date payment is due in accordance with
section 3901.381 of the Revised Code or
the contractual payment arrangement entered into under section
3901.383 of the Revised Code, and
the date payment is made. The interest rate for determining the amount of
interest due shall be equal to an annual percentage rate of eighteen per cent.
|
| (C) |
For purposes of this section,
if a dispute exists between a provider and a third-party payer as to the day a
payment was made by the third-party payer, both of the following apply:
| (1) |
If the third-party payer or a person
acting on behalf of the third-party payer submits a payment directly to a
provider by mail and retains a record of the day the payment was mailed, there
exists a rebuttable presumption that the payment was made five business days
before the day the payment was received by the provider, unless it can be
proven otherwise. |
| (2) |
If the
third-party payer or a person acting on behalf of the third-party payer submits
a payment directly to a provider electronically, there exists a rebuttable
presumption that the payment was made twenty-four hours before the date the
payment was received by the provider, unless it can be proven otherwise.
|
|
| (D) |
Interest due in
accordance with this section shall be paid directly to the provider at the time
payment of the claim is made and shall not be used to reduce benefits or
payments otherwise payable under a benefits contract. |
Effective Date:
07-24-2002 .
| (A) |
A provider
or beneficiary aggrieved with respect to any act of a third-party payer that
the provider or beneficiary believes to be a violation of sections
3901.381 to
3901.388 of the Revised Code may
file a written complaint with the superintendent of insurance regarding the
violation. |
| (B) |
A third-party
payer shall not retaliate against a provider or beneficiary who files a
complaint under division (A) of this section. If a provider or beneficiary is
aggrieved with respect to any act of the third-party payer that the provider or
beneficiary believes to be retaliation for filing a complaint under division
(A) of this section, the provider or beneficiary may file a written complaint
with the superintendent regarding the alleged retaliation. |
Effective Date:
07-24-2002 .
| (B) |
The superintendent of
insurance may require third-party payers to submit reports of their compliance
with division (A) of this section. If reports are required, the superintendent
shall prescribe the content, format, and frequency of the reports in
consultation with third-party payers. The superintendent shall not require
reports to be submitted more frequently than once every three months. The superintendent shall not use findings from reports
submitted by a third-party payer under this division as the basis of a finding
of a violation of division (A) of this section or the imposition of penalties
under section
3901.3812 of the Revised Code.
However, the information contained in the reports may cause the superintendent
to conduct a market conduct examination of the third-party payer. During this
examination, the superintendent may examine data collected from the same time
period as covered by these reports and the superintendent's examination
findings may be used as the basis for finding a violation of division (A) of
this section.
|
Effective Date:
07-24-2002 .
| (A) |
If, after completion of an examination involving
information collected from a six-month period, the superintendent finds that a
third-party payer has committed a series of violations that, taken together,
constitutes a consistent pattern or practice of violating division (A) of
section 3901.3811 of the Revised Code, the
superintendent may impose on the third-party payer any of the administrative
remedies specified in division (B) of this section. In making a finding under
this division, the superintendent shall apply the error tolerance standards for
claims processing contained in the market conduct examiners handbook issued by
the national association of insurance commissioners in effect at the time the
claims were processed. Before imposing an
administrative remedy, the superintendent shall provide written notice to the
third-party payer informing the third-party payer of the reasons for the
superintendent's finding, the administrative remedy the superintendent proposes
to impose, and the opportunity to submit a written request for an
administrative hearing regarding the finding and proposed remedy. If the
third-party payer requests a hearing, the superintendent shall conduct the
hearing in accordance with Chapter 119. of the Revised Code not later than
fifteen days after receipt of the request.
|
| (B) |
| (1) |
In imposing
administrative remedies under division (A) of this section for violations of
section 3901.381 of the Revised Code, the
superintendent may do any of the following:
| (a) |
Levy a monetary penalty in an amount determined in accordance with division
(B)(3) of this section; |
| (b) |
Order the payment of interest directly to the provider in accordance with
section 3901.389 of the Revised Code;
|
| (c) |
Order
the third-party payer to cease and desist from engaging in the violations;
|
| (d) |
If a
monetary penalty is not levied under division (B)(1)(a) of this section, impose
any of the administrative remedies provided for in section
3901.22 of the Revised Code, other
than those specified in divisions (D)(4) and (5) and (G) of that section.
|
|
| (2) |
In imposing administrative remedies under division
(A) of this section for violations of sections
3901.384 to
3901.3810 of the Revised Code, the
superintendent may do any of the following:
| (a) |
Levy a monetary penalty in an amount determined in accordance with division
(B)(3) of this section; |
| (b) |
Order the payment of interest directly to the provider in accordance with
section 3901.38 of the Revised Code;
|
| (c) |
Order
the third-party payer to cease and desist from engaging in the violations;
|
| (d) |
If a
monetary penalty is not levied under division (B)(2)(a) of this section, impose
any of the administrative remedies provided for in section
3901.22 of the Revised Code, other
than those specified in divisions (D)(4) and (5) and (G) of that section. For
violations of sections
3901.384 to
3901.3810 of the Revised Code that
did not comply with section
3901.381 of the Revised Code, the
superintendent may also use section
3901.22 of the Revised Code except
divisions (D)(4) and (5) of that section. |
|
| (3) |
A finding by the superintendent that a third-party
payer has committed a series of violations that, taken together, constitutes a
consistent pattern or practice of violating division (A) of section
3901.3811 of the Revised Code,
shall constitute a single offense for purposes of levying a fine under division
(B)(1)(a) and (B)(2)(a) of this section. For a first offense, the
superintendent may levy a fine of not more than one hundred thousand dollars.
For a second offense that occurs on or earlier than four years from the first
offense, the superintendent may levy a fine of not more than one hundred fifty
thousand dollars. For a third or additional offense that occurs on or earlier
than seven years after a first offense, the superintendent may levy a fine of
not more than three hundred thousand dollars. In determining the amount of a
fine to be levied within the specified limits, the superintendent shall
consider the following factors:
| (a) |
The extent and frequency of the violations; |
| (b) |
Whether the violations were due to circumstances beyond the third-party payer's
control; |
| (c) |
Any
remedial actions taken by the third-party payer to prevent future violations;
|
| (d) |
The
actual or potential harm to others resulting from the violations; |
| (e) |
If the third-party payer knowingly and willingly committed the violations;
|
| (f) |
The
third-party payer's financial condition; |
| (g) |
Any other factors the superintendent considers appropriate.
|
|
|
| (C) |
The remedies imposed by the superintendent under
this section are in addition to, and not in lieu of, such other remedies as
providers and beneficiaries may otherwise have by law. |
| (D) |
Any fine collected under this section shall be
paid into the state treasury as follows:
| (1) |
Twenty-five per cent of the total to the credit of the department of insurance
operating fund created by section
3901.021 of the Revised Code;
|
| (2) |
Sixty-five per cent of the total to the credit of the general revenue fund ;
|
| (3) |
Ten per
cent of the total to the credit of claims processing education
account,
which is hereby created within the department of
insurance operating fund created by section
3901.021 of the Revised
Code. All money credited to the claims processing education
account
shall be used by the department of insurance to make technical assistance
available to third-party payers, providers, and beneficiaries for effective
implementation of the provisions of sections
3901.38 and
3901.381 to
3901.3814 of the Revised Code.
|
|
Amended by
128th General AssemblyFile No.9, HB 1,
§101.01, eff.
7/17/2009.
Effective Date: 07-24-2002
.
The superintendent of insurance may adopt rules as the
superintendent considers necessary to carry out the purposes of section
3901.38 and sections
3901.381 to
3901.3812 of the Revised Code. The
rules shall be adopted in accordance with Chapter 119. of the Revised Code.
Effective Date:
07-24-2002 .
Sections
3901.38
and
3901.381
to 3901.3813 of the Revised
Code do not apply to the following:
| (A) |
Policies offering coverage that is regulated under Chapters 3935. and 3937. of
the Revised Code; |
| (B) |
An
employer's self-insurance plan and any of its administrators, as defined in
section
3959.01
of the Revised Code, to the extent that federal law supersedes, preempts,
prohibits, or otherwise precludes the application of any provisions of those
sections to the plan and its administrators; |
| (C) |
A
third-party payer for coverage provided under the medicare advantage program
operated under Title XVIII of the "Social Security Act," 49 Stat. 620 (1935),
42 U.S.C. 301, as amended; |
| (D) |
A
third-party payer for coverage provided under the medicaid program ; |
| (E) |
A
third-party payer for coverage provided under the tricare program offered by
the United States department of defense. |
Amended by
133rd General Assembly File No. TBD, HB 166, §101.01, eff.
10/17/2019.
Amended by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
10/1/2011.
Effective Date:
07-24-2002; 09-29-2005; 03-30-2006; 2008 HB562 09-22-2008 .
No insurance company, health insuring corporation, or
self-insurance plan authorized to do business in this state shall include or
provide in its policies or subscriber agreements for benefit payments or
reimbursement for services in any hospital which is not certified or accredited
as provided in division (A) of section
3727.02 of the Revised Code. No
hospital located in this state shall charge any insurance company, health
insuring corporation, federal, state, or local government agency, or person for
any services rendered unless the hospital is certified or accredited as
provided in division (A) of section
3727.02 of the Revised Code.
"Hospital" as used in this section means only those institutions included
within the definition of that term contained in section
3727.01 of the Revised Code, and
the prohibitions in this section do not apply to facilities excluded from that
definition.
Effective Date:
06-04-1997 .
| (A) |
As used in this
section:
| (1) |
"Automated transaction"
has the same meaning as in section 1306.01 of the Revised Code, and includes
electronic transactions between two or more persons conducting business
pursuant to the laws of this state relating to insurance. |
| (2) |
"Contact point" means any electronic identification to
which messages can be sent, including, but not limited to, any of the
following:
| (a) |
An electronic mail
address; |
| (b) |
An instant message
identity; |
| (c) |
A wireless telephone
number, or any other personal electronic communication device; |
|
| (3) |
"Insured" means a certificate holder, contract owner,
customer, policyholder, or subscriber as those terms are used in the laws of
this state relating to insurance. |
| (4) |
"Insurer" has the same meaning as in section 3901.32
of the Revised Code. |
| (5) |
"Laws of this state relating to insurance" has the
same meaning as in section 3901.04 of the Revised Code. |
| (6) |
"Personally identifiable information" means any
individually identifiable information gathered in connection with an insurance
transaction, including a person's name, address, social security number, and
banking information. |
| (7) |
"Secure web site" means a web site that meets both of
the following criteria:
| (a) |
The web site uses the
hypertext transfer protocol secure communication protocol or other equally
secure communication protocol. |
| (b) |
The web site requires a person to enter a unique user
credential to access personally identifiable information for which the person
has the legal right to access. |
|
|
| (B) |
Notwithstanding any laws of this state relating to
insurance, sections 1306.01 to 1306.23 of the Revised Code, the "Uniform
Electronics Transactions Act," apply to the business of insurance in this
state. |
| (C) |
| (1) |
If an insured agrees to
conduct the business of insurance via an automated transaction, any information
issued or delivered in writing may be issued or delivered electronically to a
contact point provided by the insured, as long as both of the following
apply:
| (a) |
The transmission of
information is in compliance with sections 1306.07 and 1306.14 of the Revised
Code. |
| (b) |
The details of the
automated transaction are fully disclosed to the insured in the application,
policy, certificate, contract of insurance, or by another method that ensures
notice to the insured. An insurer's form used only to notify an insured of and
obtain consent for an automated transaction does not need to be approved or
accepted by the superintendent of insurance. |
|
| (2) |
| (a) |
Except for notices of cancellation, nonrenewal, or
termination, an insurer may deliver information via a secure web site if the
insurer sends an electronic notice to a contact point and the electronic notice
includes a hyperlink to the secure web site. |
| (b) |
If an insurer uses a secure web site to deliver
changes in terms or conditions in an insured's policy, certificate, or contract
of insurance, including any endorsements or amendments, the electronic notice
to the insured's contact point shall include all of the following:
| (i) |
A list or summary of the changes; |
| (ii) |
A link to the complete document located on the
insurer's secure web site; |
| (iii) |
The following or substantially similar statement
displayed in a prominent manner: "There are changes in the terms or conditions of your
policy, certificate, or contract of insurance."
|
|
|
| (3) |
At a minimum, the details
of the automated transaction shall include all of the following:
| (a) |
A clear and conspicuous statement informing the
insured of any right or option of the insured to receive a record on
paper; |
| (b) |
The right of the insured
to withdraw the insured's consent, and any consequences or fees if the insured
withdraws consent; |
| (c) |
A description of the procedures the insured must use
to withdraw consent and to update the insured's contact point. |
|
| (4) |
Agreement to participate
in a part of an automated transaction shall not be used to confirm the
insured's consent to transact the entire business of insurance pursuant to this
section. |
| (5) |
A withdrawal of consent
by an insured shall be effective within a reasonable time period, not to exceed
ten business days after the receipt of the withdrawal by the insurer. |
|
| (D) |
The insurer shall send
all notices of cancellation, nonrenewal, termination, or changes in the terms
or conditions of the policy, certificate, or contract of insurance to the last
known contact point supplied by the insured. If the insurer has knowledge that
the insured's contact point is no longer valid, the insurer shall send the
information via regular mail to the last known address furnished to the insurer
by the insured. |
| (E) |
Any insurer conducting the business of insurance via
an automated transaction shall allow the insurer's insureds who agree to
participate in an automated transaction the option to withdraw consent from
participating in the automated transaction. |
| (F) |
Notwithstanding any laws or regulations of this state
relating to insurance, any policy, certificate, or contract of insurance,
including any endorsements or amendments, that do not contain personally
identifiable information may be posted to the insurer's web site in lieu of any
other method of delivery. If the insurer elects to post any policy,
certificate, or contract of insurance to the insurer's web site, all of the
following shall apply:
| (1) |
The policy, certificate,
or contract of insurance is readily accessible by the insured and, once the
policy, certificate, or contract of insurance is no longer used by the insurer
in this state, it is stored in a readily accessible archive; |
| (2) |
The policy, certificate, or contract of insurance is
posted in such a manner that the insured can easily identify the insured's
applicable policy, certificate, or contract and print or download the insured's
documents without charge and without the use of any special program or
application that is not readily available to the public without charge; |
| (3) |
The insurer provides
written notice at the time of issuance of the initial policy, certificate,
contract, or any renewal forms of a method by which the insured may obtain upon
request a paper or electronic copy of their policy, certificate, or contract
without charge; |
| (4) |
The insurer clearly identifies the applicable policy,
endorsements, amendments, certificate, or contract of insurance purchased by
the insured on any declaration page, certificate of insurance, summary of
benefits, or other evidence of coverage issued to the insured; |
| (5) |
The insurer gives notice, in the manner it customarily
communicates with an insured, of any changes to the policy, certificate, or
contract of insurance, including any endorsements or amendments, and of the
insured's right to obtain upon request a paper or electronic copy of the
policy, endorsements, or amendments without charge. |
|
| (G) |
Notwithstanding any other section of Title XXXIX or
Chapters 1739. or 1751. of the Revised Code or rules adopted thereunder to the
contrary, an insurer may deliver any notices, documents, or information to an
insured via an automated transaction pursuant to this section. |
| (H) |
This section does not supersede any time periods,
filing requirements, or content of notices, documents, notices to insureds'
agents required pursuant to sections 3937.25, 3937.26, and 3937.27 of the
Revised Code, or information otherwise required by a law other than this
section relating to insurance. This section does not apply to disclosures
through electronic media of certificates, explanation of benefit statements,
and other mandated materials under the "Employee Retirement Income Security Act
of 1974," 88 Stat. 829, 29 U.S.C. 1001, as amended, and any regulation adopted
thereunder. |
| (I) |
If the consent of an
insured to receive certain notices, documents, or information in an electronic
form is on file with an insurer before the effective date of this section, if
the consent was not accompanied by the details of the automated transaction
described in division (C)(3) of this section, and if, pursuant to this section,
an insurer intends to deliver additional notices, documents, or information to
that insured in an electronic form, then, prior to delivering or at the time of
delivering such additional notice, documents, or information electronically,
the insurer shall notify the insured of the details of the automated
transaction in compliance with division (C)(3) of this section. |
| (J) |
The superintendent of
insurance may adopt rules in accordance with Chapter 119. of the Revised Code
as the superintendent considers necessary to carry out the purposes of this
section. |
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
As used in
this section, "actuarial certification" means certification by a member in good
standing of the American Academy of Actuaries, or a person who otherwise has
competency in loss reserve valuation. |
| (B) |
Each domestic, foreign, and alien insurer
authorized to transact insurance in this state shall, annually on or before the
first day of March of each year, file with the national association of
insurance commissioners a copy of its annual statement convention blank, along
with such additional filings as prescribed by the superintendent of insurance
for the preceding year. The information filed with the association shall be in
the same format and scope as that required by the superintendent and shall
include the signed jurat page and the actuarial certification, as required by
the state of domicile. Any amendments and addendums to the annual statement
filing subsequently filed with the superintendent shall also be filed with the
association. |
| (C) |
Foreign insurers
that are domiciled in a state that has a law substantially similar to division
(B) of this section are deemed in compliance with this section. |
| (D) |
In the absence of actual malice,
members, delegates, and employees of the national association of insurance
commissioners, its authorized committees, subcommittees, and task forces, and
all others charged with the responsibility of collecting, reviewing, analyzing,
and disseminating the information developed from the filing of the annual
statement convention blanks shall be acting as agents of the superintendent
under the authority of this section and are not subject to civil liability for
libel, slander, or any other cause of action by virtue of their collection,
review, and analysis or dissemination of the data and information collected
from the filings required under this section. |
| (E) |
| (1) |
In addition
to the annual statement required to be filed with the national association of
insurance commissioners under division (B) of this section, the superintendent
may require an insurer to file with the superintendent, on or before the
forty-fifth day following the last day of each calendar quarter, quarterly
reports showing its condition for each of the first three calendar quarters.
|
| (2) |
The quarterly report shall
consist of information that the superintendent considers to be relevant to the
determination of the solvency of an insurer. |
|
| (F) |
The superintendent may, pursuant to Chapter 119.
of the Revised Code, suspend, revoke, or refuse to renew the license to engage
in the business of insurance of any insurer that fails to file its annual
statement within the time required under division (B) of this section or a
quarterly report within the time required under division (E) of this section,
or within any extension of time which the superintendent, for good cause, may
have granted. |
Effective Date:
06-18-1986 .
Effective Date:
06-18-2002 .
| (A) |
As used in
this section, "insurance fraud investigation" means any investigation conducted
by the superintendent of insurance or a designee of the superintendent that
relates to a fraudulent insurance act as defined in section
3999.31 of the Revised Code.
|
| (B) |
All documents, reports, and
evidence in the possession of the superintendent or the superintendent's
designee that pertain to an insurance fraud investigation are confidential law
enforcement investigatory records under section
149.43 of the Revised Code.
Notwithstanding such section, the superintendent shall not prohibit public
inspection of such records that pertain to an insurance fraud investigation
after the expiration of all federal and state statutes of limitations
applicable to the particular offense to which the papers, documents, reports,
and evidence relate. |
| (C) |
All
documents, reports, and evidence in the possession of the superintendent that
do not pertain to such an insurance fraud investigation are public records
under section
149.43 of the Revised Code, and are
not by such possession alone confidential law enforcement investigatory
records. |
| (D) |
All documents,
reports, and evidence in the possession of the superintendent or the
superintendent's designee that pertain to such an insurance fraud investigation
are not subject to subpoena in civil actions by any court of this state until
opened for public inspection by the superintendent in accordance with division
(B) of this section or with section
149.43 of the Revised Code, unless
the superintendent or the superintendent's designee consents, or until after
reasonable notice to the superintendent and opportunity for hearing, the court
determines the superintendent would not be hindered unnecessarily by such
subpoena. |
| (E) |
Notwithstanding
divisions (B), (C), and (D) of this section, the superintendent may do either
of the following:
| (1) |
Share documents,
reports, and evidence that are the subject of this section with the chief
deputy rehabilitator, the chief deputy liquidator, other deputy rehabilitators
and liquidators, and any other person employed by, or acting on behalf of, the
superintendent pursuant to Chapter 3901. or 3903. of the Revised Code, with
other local, state, federal, and international regulatory and law enforcement
agencies, with local, state, and federal prosecutors, with the national
association of insurance commissioners and its affiliates and subsidiaries,
with insurers, and with investigators hired by insurers, provided that the
recipient agrees to maintain the confidential or privileged status of the
confidential or privileged document, report, or evidence and has authority to
do so; |
| (2) |
Disclose documents,
reports, and evidence that are the subject of this section in the furtherance
of any regulatory or legal action brought by or on behalf of the superintendent
or the state, resulting from the exercise of the superintendent's official
duties. |
|
| (F) |
Notwithstanding divisions (B), (C), (D), and (E) of this section, the
superintendent may authorize the national association of insurance
commissioners and its affiliates and subsidiaries by agreement to share
confidential or privileged documents, reports, and evidence received pursuant
to division (E)(1) of this section with local, state, federal, and
international regulatory and law enforcement agencies and with local, state,
and federal prosecutors, provided that the recipient agrees to maintain the
confidential or privileged status of the confidential or privileged document,
report, or evidence and has authority to do so. |
| (G) |
Notwithstanding divisions (B), (C), (D), and (E)
of this section, the chief deputy rehabilitator, the chief deputy liquidator,
and other deputy rehabilitators and liquidators may disclose documents,
reports, and evidence that are the subject of this section in the furtherance
of any regulatory or legal action brought by or on behalf of the
superintendent, the rehabilitator, the liquidator, or the state resulting from
the exercise of the superintendent's official duties in any capacity.
|
| (H) |
Nothing in this section shall
prohibit the superintendent from receiving documents, reports, and evidence in
accordance with section
3901.045 of the Revised Code.
|
| (I) |
The superintendent may enter
into agreements governing the sharing and use of documents, reports, and
evidence consistent with the requirements of this section. |
| (J) |
| (1) |
No waiver
of any applicable privilege or claim of confidentiality in the documents,
reports, and evidence described in this section shall occur as a result of
sharing or receiving documents, reports, and evidence as authorized in
divisions (E)(1), (F), and (H) of this section. |
| (2) |
The disclosure of a document, report, or evidence
in connection with a regulatory or legal action pursuant to divisions (E)(2)
and (G) of this section does not prohibit an insurer or any other person from
taking steps to limit the dissemination of the document, report, or evidence to
persons not involved in or the subject of the regulatory or legal action on the
basis of any recognized privilege arising under any other section of the
Revised Code or the common law. |
|
| (K) |
The superintendent and the superintendent's
designee are not subject to subpoena in civil actions by any court of this
state to testify concerning any matter of which they have knowledge pursuant to
a pending insurance fraud investigation by the superintendent. |
Effective Date:
06-18-2002 .
| (A) |
As used in
sections
3901.45
and
3901.46 of
the Revised Code:
| (1) |
"AIDS,"
"HIV," "AIDS-related condition," and "HIV test" have the same meanings as in
section
3701.24
of the Revised Code. |
| (2) |
"Insurer"
means any person authorized to engage in the business of life or sickness and
accident insurance under Title XXXIX of the Revised Code or any person or
governmental entity providing health services coverage for individuals on a
self-insurance basis. |
| (3) |
"Group
policy" means, with respect to life insurance, a policy covering more than
twenty-five individuals and issued pursuant to section
3917.01
of the Revised Code, and with respect to sickness and accident insurance, a
policy covering more than twenty-five individuals and issued pursuant to
section
3923.11,
3923.12,
or
3923.13
of the Revised Code. "Group policy" includes a certificate of life or sickness
and accident insurance covering more than twenty-five individuals under a group
policy issued to a multiple employer trust. |
| (4) |
"Individual policy" means, with respect to life insurance and sickness and
accident insurance, a policy other than a group policy, except that "individual
policy" also includes all of the following:
| (a) |
The
coverage under a group policy of an individual who seeks to become a member of
an insured group after having declined a previous offer of coverage under the
group policy; |
| (b) |
An
individual who seeks life insurance coverage under a group policy in excess of
the maximum coverage available under the policy without evidence of
insurability; |
| (c) |
A
certificate of life or sickness and accident insurance covering no more than
twenty-five individuals under a group policy issued to a multiple employer
trust. |
|
|
| (B) |
In
processing an application for an individual policy of life or sickness and
accident insurance or in determining insurability of an applicant, no insurer
shall:
| (1) |
Take into
consideration an applicant's sexual orientation; |
| (2) |
Make any inquiry toward determining an applicant's sexual orientation or direct
any person who provides services to the insurer to investigate an applicant's
sexual orientation; |
| (3) |
Make a
decision adverse to the applicant based on entries in medical records or other
reports that show that the applicant has sought an HIV test, consultation
regarding the possibility of developing AIDS or an AIDS-related condition, or
counseling for concerns related to AIDS from health care professionals unless
there has been a diagnosis, confirmed by a positive HIV test, of AIDS or an
AIDS-related condition or the applicant has been treated for either. |
|
| (C) |
| (1) |
In
developing and asking questions regarding medical histories and lifestyles of
applicants for life or sickness and accident insurance and in assessing the
answers, an insurer shall not ask questions designed to ascertain the sexual
orientation of the applicant nor use factors such as marital status, living
arrangements, occupation, gender, medical history, beneficiary designation, or
zip code or other geographic designation to aid in ascertaining the applicant's
sexual orientation. |
| (2) |
An insurer
may ask the applicant if the applicant has ever been diagnosed as having
AIDS or an AIDS-related condition. |
| (3) |
An
insurer may ask the applicant specifically whether the applicant
has ever had a positive result on an HIV test. "Positive result" means a result
interpreted as positive in accordance with guidelines developed by the director
of health under division (B)(1) of
section
3701.241
of the Revised Code, even though the applicant may have been tested in another
state. "Positive result" does not mean an initial positive result that further
testing showed to be false. |
| (4) |
The
insurer shall not ask the applicant whether the applicant
has ever taken an HIV test. |
|
| (D) |
| (1) |
Except as provided in division (D)(2) of this section, no insurer shall cancel
a policy of life or sickness and accident insurance, or refuse to renew a
policy of life or sickness and accident insurance other than a policy that is
renewable at the option of the insurer, based solely on the fact that, after
the effective date of the policy, the policyholder is diagnosed as having AIDS,
an AIDS-related condition, or an HIV infection. |
| (2) |
If
a policy of life or sickness and accident insurance provides for a
contestability period, an insurer may cancel the policy during the
contestability period if the applicant made a false statement in the
application with regard to the question of whether the applicant
has been diagnosed as having AIDS, an AIDS-related condition, or an HIV
infection. |
|
| (E) |
No insurer
shall deliver, issue for delivery, or renew a policy of life or sickness and
accident insurance that limits benefits or coverage in the event that, after
the effective date of the policy, the insured develops AIDS or an AIDS-related
condition or receives a positive result on an HIV test. |
| (F) |
An
insurer is not required to offer coverage under a policy of life or sickness
and accident insurance to an individual or group member, or a dependent of an
individual or group member, who has AIDS or an AIDS-related condition, or who
has had a positive result on an HIV test. |
| (G) |
An
insurer is not required to continue to provide coverage under a policy of life
or sickness and accident insurance to an individual or group member, or a
dependent of an individual or group member, if the insurer determines the
individual or group member or dependent of the individual or group member knew
on the effective date of the policy that the individual or
group member or dependent of the individual or group member had AIDS, an
AIDS-related condition, or a positive result of an HIV test. |
| (H) |
A
violation of this section is an unfair insurance practice under sections
3901.19
to
3901.26
of the Revised Code. |
Amended by
133rd General Assembly File No. TBD, HB 339, §1,
eff. 1/1/2021.
Effective Date:
11-01-1989 .
As used in this section, "membership organization" means a
fraternal or other association or group of individuals involved in the same
occupation, activity, or interest that is organized and maintained in good
faith for purposes other than to obtain insurance and is not organized or
maintained for the purpose of engaging in activities for gain or profit.
| (A) |
In underwriting an individual
policy of life or sickness and accident insurance or a group policy of life or
sickness and accident insurance providing coverage for members of a membership
organization, an insurer may require an applicant for coverage under the policy
to submit to an HIV test only in conjunction with tests for other health
conditions. No applicant shall be required to submit to an HIV test on the
basis of the applicant's sexual orientation or factors described in division
(C)(1) of section
3901.45 of the Revised Code that
are used to ascertain the applicant's sexual orientation. |
| (B) |
| (1) |
An insurer
that requests an applicant to take an HIV test shall obtain the applicant's
written consent for the test and shall inform the applicant of the purpose of
the test. The consent form shall include information about the tests to be
performed, the confidentiality of the results, procedures for notifying the
applicant of the results, and a general interpretation of test results.
|
| (2) |
The superintendent of
insurance shall adopt rules under Chapter 119. of the Revised Code establishing
the form and content of the consent required under division (B)(1) of this
section. |
|
| (C) |
An
insurer may disclose the results of a positive HIV test only to the following
persons:
| (2) |
The applicant's or insured's physician or
other health care provider if the applicant or insured provides the insurer
with prior written consent for disclosure; |
| (3) |
Another person that the applicant or
insured specifically designates in writing; |
| (4) |
A medical information exchange for
insurers operated under procedures intended to ensure confidentiality,
including the use of general codes for results of tests for a number of
diseases and conditions as well as for AIDS or an AIDS-related condition.
|
|
| (D) |
The HIV test or
tests to be given the applicant shall be a test or tests approved by the
director of health pursuant to division (B) of section
3701.241 of the Revised Code. Test
results shall be interpreted strictly in accordance with guidelines for the use
of the tests adopted by the director. |
| (E) |
The requirements of division (B) of section
3701.24 and sections
3701.242 and
3701.243 of the Revised Code do
not apply to insurers in the underwriting of an individual policy of life or
sickness and accident insurance or of a group policy of life or sickness and
accident insurance providing coverage for members of a membership organization,
except that an insurer may make use of the procedures in division (C) of
section 3701.243 of the Revised Code.
|
| (F) |
In underwriting a group
policy of life or sickness and accident insurance, no insurer shall require an
individual seeking coverage, other than an individual seeking coverage under
the policy of a membership organization, to submit to an HIV test. |
| (G) |
A violation of this section is an unfair
insurance practice under sections
3901.19 to
3901.26 of the Revised Code.
|
Effective Date:
02-12-2004 .
| (A) |
As used in
this section:
| (1) |
"Insurer" means any insurer
authorized to write life or sickness and accident insurance in this state under
Title XXXIX [39] of the Revised Code. |
| (2) |
"Insolvent insurer" means any of the
following:
| (a) |
Farm and ranch life insurance
company, domiciled in the state of Kansas; |
| (b) |
First transcontinental life insurance
corporation, domiciled in the state of Wisconsin; |
| (c) |
Lumbermen's life insurance company,
domiciled in the state of Indiana; |
| (d) |
United fire insurance company, domiciled
in the state of Illinois; |
| (e) |
Any
other insurer that, not later than June 30, 1990, is under an order of
liquidation issued by a court of competent jurisdiction; |
| (f) |
Any person that is organized under the
laws of another state as a nonprofit hospital service association, corporation,
or plan, that is authorized by the laws of that state to offer sickness and
accident benefits for hospital services under group subscriber contracts, that
has furnished certificates in connection with or pursuant to these contracts to
subscribers residing or employed in this state, and that, not later than June
30, 1990, is under an order of liquidation issued by a court of competent
jurisdiction. Division (A)(2)(f) of this section does not include any person
organized as a health maintenance organization or an indemnity insurance
company. |
|
| (3) |
"Ohio
claimant" means a policyholder or a contract holder under an individual policy,
or a certificate holder under a group policy or contract, of an insolvent
insurer who is owed life, sickness and accident, or annuity benefits pursuant
to the terms of policies of insurance issued by that insurer.
|
|
| (B) |
The superintendent
of insurance, in furtherance of section
3901.011,
3903.17, or
3903.53 of the Revised Code, may
file a complaint in the court of common pleas of Franklin county for an order
appointing him, whether as liquidator, ancillary receiver, or otherwise, to
make arrangements for the distribution of voluntary contributions made in
accordance with division (E) of this section. As part of the complaint, the
superintendent shall submit a written plan for the administration of the
contributions. The plan shall include, but need not be limited to, procedures
for receipt, maintenance, and distribution of the contributions and for the
adjudication and subrogation of the claims to be paid. If a life and health
insurance guaranty association is in existence in this state, the
superintendent may direct the association to perform the administrative duties
set forth in the plan. |
| (C) |
The
superintendent shall take all reasonable and necessary actions to implement the
plan as described in division (B) of this section. As part of these actions,
all of the following apply:
| (1) |
The
superintendent shall seek a full pro rata recovery of the assets of the
liquidation estates that are due Ohio claimants pursuant to Chapter 3903. of
the Revised Code and the insurance liquidation laws of the states of domicile
of the insolvent insurers; |
| (2) |
The
superintendent shall be subrogated to all claims of Ohio claimants in the fully
adjudicated amounts. These amounts are not reduced by payments from funds
voluntarily contributed. |
| (3) |
| (a) |
The superintendent shall attempt to
secure payment of the claims adjudicated pursuant to the plan as described in
division (B) of this section. |
| (b) |
No Ohio claimant is entitled to receive more than one hundred per cent of the
adjudicated amounts of his claims. If any claimant receives more than one
hundred per cent, the superintendent may undertake legal action to recover the
amounts in excess of one hundred per cent from the claimant. The related
liquidation estates shall be obligated to pay the costs incurred by the
superintendent to recover these amounts. |
|
| (4) |
Voluntary contributions held by any
person are not the property of any insolvent insurer. Distribution to Ohio
claimants of the funds voluntarily contributed are not payments on behalf of
any insolvent insurer, and do not lose their legal status as voluntary
contributions. |
| (5) |
Payment to Ohio
claimants of any of the funds voluntarily contributed does not reduce their
claims against an insolvent insurer if those claims have been subrogated to the
superintendent. |
|
| (D) |
Any
funds remaining in excess of the aggregate total of all claims and
administrative expenses of Ohio claimants shall be transferred to a life and
health insurance guaranty association that may be in existence in this state
for use in payment of administrative costs or claims related to subsequent
insolvencies. If the association does not exist, the excess funds shall be
distributed pro rata to the contributing insurers and appropriate adjustments
shall be made by the superintendent in the premium or franchise tax liability
of those contributing insurers. |
| (E) |
| (1) |
Any insurer
that, not later than June 30, 1990, and in accordance with the plan described
in division (B) of this section, voluntarily contributes funds to pay the life,
sickness and accident, or annuity claims of residents of this state that are
unpaid due to the insolvency of an insolvent insurer may offset against its
premium or franchise tax liability twenty per cent of the contribution for each
of the first five calendar years following the year in which the contribution
was made. |
| (2) |
If that portion of
the aggregate total of the contributions described in division (E)(1) of this
section that is eligible for offset in a particular year exceeds an insurer's
tax liability to this state for that year, the amount in excess of that tax
liability that remains eligible for offset, notwithstanding the five-year
limitation set forth in division (E)(1) of this section, may be offset against
that tax liability in future years. |
| (3) |
Contributions used to defray the costs of
administering the plan as described in division (B) of this section qualify for
treatment as contributions eligible for the tax offset provided in division
(E)(1) of this section. |
|
| (F) |
| (1) |
An insurer
is not subject to liability for damages arising out of a civil action of any
nature for making voluntary contributions in accordance with division (E) of
this section or for otherwise participating in the plan described in division
(B) of this section. |
| (2) |
Any life
and health guaranty association directed by the superintendent to perform
administrative duties set forth in the plan described in division (B) of this
section is not subject to liability for damages arising out of a civil action
of any nature for participating in that plan. |
| (3) |
Funds voluntarily pledged, committed, or
contributed by an insurer in accordance with division (E) of this section are
not subject to attachment, lien, execution, or other legal actions brought by
persons other than the superintendent pursuant to his responsibilities under
the plan described in division (B) of this section. |
|
Effective Date:
11-20-1989 .
| (A) |
The
original work papers of a certified public accountant performing an audit of an
insurance company or health insuring corporation doing business in this state
that is required by rule or by any section of the Revised Code to file an
audited financial report with the superintendent of insurance shall remain the
property of the certified public accountant. Any copies of these work papers
voluntarily given to the superintendent shall be the property of the
superintendent. The original work papers or any copies of them, whether in
possession of the certified public accountant or the department of insurance,
are confidential and privileged and are not a public record as defined in
section 149.43 of the Revised Code. The
original work papers and any copies of them are not subject to subpoena and
shall not be made public by the superintendent or any other person. |
| (B) |
The work papers of the superintendent or
of the person appointed by the superintendent, resulting from the conduct of an
examination made pursuant to section
3901.07 of the Revised Code or
from the conduct of a financial analysis of any entity subject to examination
by the superintendent, including but not limited to any insurance company,
health insuring corporation, fraternal benefit society, or multiple employer
welfare arrangement, are confidential and privileged and are not a public
record as defined in section
149.43 of the Revised Code. The
original work papers and any copies of them are not subject to subpoena and
shall not be made public by the superintendent or any other person. |
| (C) |
The work papers of the superintendent or
of any person appointed by the superintendent, resulting from the conduct of a
performance regulation examination made pursuant to authority granted under
section 3901.011 of the Revised Code or
from the conduct of a market analysis or investigation of any entity subject to
examination by the superintendent, including, but not limited to, any insurance
company, health insuring corporation, fraternal benefit society, or multiple
employer welfare arrangement, are confidential and privileged and are not a
public record as defined in section
149.43 of the Revised Code. The
original work papers and any copies of them are not subject to subpoena and
shall not be made public by the superintendent or any other person. |
| (D) |
Notwithstanding divisions (A), (B), and
(C) of this section, the superintendent may do either of the following:
| (1) |
Share work papers that are the subject of
this section with the chief deputy rehabilitator, the chief deputy liquidator,
other deputy rehabilitators and liquidators, and any other person employed by,
or acting on behalf of, the superintendent pursuant to Chapter 3901. or 3903.
of the Revised Code, with other local, state, federal, and international
regulatory and law enforcement agencies, with local, state, and federal
prosecutors, with the national association of insurance commissioners and its
affiliates and subsidiaries, and with the interstate insurance product
regulation commission described in section
3915.16 of the Revised Code,
provided that the recipient agrees to maintain the confidential or privileged
status of the confidential or privileged work paper and has authority to do so;
|
| (2) |
Disclose work papers that are
the subject of this section in the furtherance of any regulatory or legal
action brought by or on behalf of the superintendent or the state, resulting
from the exercise of the superintendent's official duties. |
|
| (E) |
Notwithstanding divisions (A), (B), (C),
and (D) of this section, the superintendent may authorize the national
association of insurance commissioners and its affiliates and subsidiaries or
the interstate insurance product regulation commission described in section
3915.16 of the Revised Code by
agreement to share confidential or privileged work papers received pursuant to
division (D)(1) of this section with local, state, federal, and international
regulatory and law enforcement agencies and with local, state, and federal
prosecutors, provided that the recipient agrees to maintain the confidential or
privileged status of the confidential or privileged work paper and has
authority to do so. |
| (F) |
Notwithstanding divisions (A), (B), (C), and (D) of this section, the chief
deputy rehabilitator, the chief deputy liquidator, and other deputy
rehabilitators and liquidators may disclose work papers that are the subject of
this section in the furtherance of any regulatory or legal action brought by or
on behalf of the superintendent, the rehabilitator, the liquidator, or the
state resulting from the exercise of the superintendent's official duties in
any capacity. |
| (G) |
Nothing in this
section shall prohibit the superintendent from receiving work papers in
accordance with section
3901.045 of the Revised Code.
|
| (H) |
The superintendent may enter
into agreements governing the sharing and use of work papers consistent with
the requirements of this section. |
| (I) |
| (1) |
No waiver
of any applicable privilege or claim of confidentiality in the work papers, or
copies thereof, that are the subject of this section shall occur as a result of
sharing or receiving work papers as authorized in divisions (D)(1), (E), and
(G) of this section. |
| (2) |
The
disclosure of work papers in connection with a regulatory or legal action
pursuant to divisions (D)(2) and (F) of this section does not prohibit an
insurer or any other person from taking steps to limit the dissemination of the
work papers to persons not involved in or the subject of the regulatory or
legal action on the basis of any recognized privilege arising under any other
section of the Revised Code or the common law. |
|
Effective Date:
06-18-2002;
08-21-2006 .
Effective Date:
02-09-2004 .
| (A) |
As used in this section:
| (1) |
"Genetic screening or testing" means a laboratory test of a person's genes or
chromosomes for abnormalities, defects, or deficiencies, including carrier
status, that are linked to physical or mental disorders or impairments, or that
indicate a susceptibility to illness, disease, or other disorders, whether
physical or mental, which test is a direct test for abnormalities, defects, or
deficiencies, and not an indirect manifestation of genetic disorders. |
| (2) |
"Insurer" means any person authorized under Title XXXIX of the Revised Code to
engage in the business of sickness and accident insurance. |
| (3) |
"Sickness and accident insurance" means sickness and accident insurance under
Chapter 3923. of the Revised Code excluding disability income insurance and
excluding supplemental policies of sickness and accident
insurance. |
|
| (B) |
No insurer or public employee benefit plan shall do either of the
following:
| (1) |
Consider
any information obtained from genetic screening or testing in processing an
application for an individual or group policy of sickness and accident
insurance or public employee benefit plan, or in
determining insurability under such a policy or
plan; |
| (2) |
Inquire,
directly or indirectly, into the results of genetic screening or testing or use
such information, in whole or in part, to cancel, refuse to issue or renew,
limit benefits under,
or set premiums for a sickness and accident
insurance policy or public employee benefit
plan. |
|
| (C) |
Any insurer or plan
that has engaged in, is engaged in, or is about to engage in a violation of
division (B) of this section is subject to the jurisdiction of the
superintendent of insurance under section
3901.04 of the Revised
Code. |
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Effective Date: 09-26-2003
.
Effective Date:
02-09-2004 .
| (A) |
As used in
this section:
| (1) |
"Genetic screening or
testing" means a laboratory test of a person's genes or chromosomes for
abnormalities, defects, or deficiencies, including carrier status, that are
linked to physical or mental disorders or impairments, or that indicate a
susceptibility to illness, disease, or other disorders, whether physical or
mental, which test is a direct test for abnormalities, defects, or
deficiencies, and not an indirect manifestation of genetic disorders.
|
| (2) |
"Self-insurer" means any
government entity providing coverage for health care services on a
self-insurance basis. |
|
| (B) |
Upon the repeal of section
3901.50 of the Revised Code , no
self-insurer shall do either of the following:
| (1) |
Consider any information obtained from
genetic screening or testing in processing an application for coverage under a
plan of self-insurance or in determining insurability under such a plan;
|
| (2) |
Inquire, directly or
indirectly, into the results of genetic screening or testing or use such
information, in whole or in part, to cancel, refuse to provide or renew, or
limit benefits under, a plan of self-insurance. |
|
| (C) |
Any self-insurer that has engaged in, is engaged
in, or is about to engage in a violation of division (B) of this section is
subject to the jurisdiction of the superintendent of insurance under section
3901.04 of the Revised Code.
|
Effective Date:
09-26-2003 .
As used in sections 3901.51 to
3901.55 of the Revised Code:
| (A) |
"Clearing corporation" has the
same meaning as in section
1308.01 of the Revised Code,
except that with respect to securities issued by institutions organized or
existing under the laws of any foreign country or securities used to meet the
deposit requirements pursuant to the laws of a foreign country as a condition
of doing business in that country, "clearing corporation" includes a
corporation that is organized or existing under the laws of any foreign country
and is legally qualified under those laws to effect transactions in securities
by computerized book-entry. |
| (B) |
"Direct participant" means a bank, trust company, or other entity that
maintains an account in its name in a clearing corporation and through which an
insurance company participates in a clearing corporation. |
| (C) |
"Federal reserve book-entry system" means the
computerized systems sponsored by the United States department of the treasury
and agencies and instrumentalities of the United States for holding and
transferring securities of the United States government and agencies and
instrumentalities in federal reserve banks through banks that are members of
the federal reserve system or that otherwise have access to these computerized
systems. |
| (D) |
"Member bank" means
a national or state bank or a trust company that is a member of the federal
reserve system and through which an insurance company participates in the
federal reserve book-entry system. |
| (E) |
"Provisions of the insurance laws of this state"
means provisions of Title IX of the Revised Code related to the deposit of
securities for the benefit and security of policyholders, and includes, but is
not limited to, sections
3901.18,
3901.74,
3901.75,
3901.86,
3903.73,
3907.07,
3909.03,
3909.09,
3909.17,
3913.01,
3913.04,
3919.13,
3919.36,
3919.37,
3919.41,
3925.07,
3927.02,
3927.06,
3929.01,
3929.07,
3929.08,
3929.09,
3929.10,
3929.11,
3941.30,
3941.31,
3941.32,
3941.33,
3941.34,
3941.42,
3953.06, and
3953.11 of the Revised Code.
|
| (F) |
"Securities" has the same
meaning as in section
1308.01 of the Revised Code.
|
Effective Date:
08-06-2004 .
| (A) |
An
insurance company may place or arrange for the placement of securities held in
or purchased for its general account and its separate accounts in a clearing
corporation or the federal reserve book-entry system. Ownership of, and other
interest in, these securities may be transferred by bookkeeping entry on the
books of the clearing corporation or in the federal reserve book-entry system
without physical delivery of certificates representing these securities.
|
| (B) |
The records of any member
bank through which an insurance company holds securities in the federal reserve
book-entry system, and the records of any direct participant through which an
insurance company holds securities in a clearing corporation, shall show at all
times that the securities are held for that insurance company and for which
accounts of that insurance company they are held. |
| (C) |
When securities are placed with a clearing
corporation, certificates representing securities of the same class of the same
issuer may be merged and held in bulk in the name of the nominee of the
clearing corporation with any other securities placed with the clearing
corporation by any person regardless of the ownership of the securities, and
certificates representing securities of small denominations may be merged into
one or more certificates of larger denominations. |
Effective Date:
09-28-1990 .
| (A) |
Securities
that are eligible for deposit under provisions of the insurance laws of this
state may be placed with a clearing corporation or held in the federal reserve
book-entry system. |
| (B) |
When an
insurance company places or arranges for the placement of securities in a
clearing corporation or in the federal reserve book-entry system, the
securities so placed shall satisfy the deposit requirements under provisions of
the insurance laws of this state, if all of the following conditions are
satisfied:
| (1) |
The securities shall be under
the control of the superintendent of insurance; |
| (2) |
The securities shall not be withdrawn by
the insurance company without the written approval of the superintendent;
|
| (3) |
The placement shall be made
pursuant to a written agreement between the insurance company and a direct
participant or member bank. The agreement shall be approved in writing by the
superintendent and shall limit withdrawals to those having the written approval
of the department of insurance. |
| (4) |
The placement shall be credited by the department as a deposit in its
possession on the basis of an affidavit of the insurance company describing the
amount and nature of the securities; |
| (5) |
The insurance company holding the
securities shall provide the superintendent with both of the following:
| (a) |
Evidence issued by its direct participant
or the member bank through which it has placed securities in a clearing
corporation or in the federal reserve book-entry system. The evidence shall be
in a form that is sufficient to establish that the securities are actually
recorded in an account in the name of the direct participant or member bank.
|
| (b) |
Evidence issued by its direct
participant or the member bank that the records of the direct participant or
member bank reflect that the securities are held subject to the written order
of the superintendent. |
|
|
Effective Date:
09-28-1990 .
No insurance company shall use, for any purpose other than to
satisfy the deposit requirements under provisions of the insurance laws of this
state, securities that have been placed in a clearing corporation or in the
federal reserve book-entry system for the satisfaction of these requirements
pursuant to division (B) of section
3901.53 of the Revised Code.
Effective Date:
09-28-1990 .
The superintendent of insurance may adopt rules pursuant to
Chapter 119. of the Revised Code to carry out the purposes of sections
3901.51,
3901.52, and
3901.53 of the Revised Code.
Effective Date:
09-28-1990 .
An insurer may offer a wellness or health improvement
program that provides rewards or incentives, including merchandise; gift cards;
debit cards; premium discounts or rebates; contributions to a health savings
account; modifications to copayment, deductible, or coinsurance amounts; or any
combination of these incentives, to encourage participation or to reward
participation in the program.
A wellness or health improvement program offered by an
insurer under this section shall not be construed to violate division (E) of
section 1751.31 or division (G) of section
3901.21 of the Revised Code if the
program is disclosed in the policy or plan.
The insured may be required to provide verification,
such as a statement from their physician, that a medical condition makes it
unreasonably difficult or medically inadvisable for the individual to
participate in the wellness or health improvement program.
Nothing in this section shall prohibit an insurer from
offering incentives or rewards to members for adherence to wellness or health
improvement programs if otherwise allowed by federal law.
Nothing under division (C)(1) of section
3923.571 or section
3924.25 of the Revised Code shall
be construed as prohibiting an insurer from offering a wellness or health
improvement program or restricting the amount an employee is charged for
coverage under a group policy after the application of any premium discounts or
rebates, or modifying otherwise applicable copayments or deductibles for
adherence to wellness or health improvement programs.
For purposes of this section, "insurer" means a life
insurance company, sickness and accident insurer, multiple employer welfare
arrangement, public employee benefit plan, or health insuring
corporation.
Added by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
As used in sections 3901.61 to
3901.65 of the Revised Code:
| (A) |
"Assuming insurer" means an
insurance company that accepts all or part of the risk underwritten by a ceding
insurer. |
| (B) |
"Ceding insurer"
means an insurance company that transfers all or part of the risk it
underwrites to an assuming insurer. |
Effective Date:
06-29-1994 .
| (A) |
Except as provided in sections 3901.63 and 3901.64
of the Revised Code, a domestic ceding insurer that is authorized to do any
insurance business in this state may take credit for any reinsurance ceded as
either an asset or a reduction of liability only if one of the following
applies:
| (1) |
The
reinsurance is ceded to an assuming insurer that is authorized to do any
insurance or reinsurance business in this state. |
| (2) |
The reinsurance is ceded to an assuming insurer that is
accredited by the superintendent of insurance as a reinsurer in this state in
accordance with division (B) of this section. |
| (3) |
The
reinsurance is ceded to an assuming insurer that is not authorized to do any
insurance or reinsurance business in this state, provided the reinsurance is
ceded to a reinsurance pool or other risk-sharing entity in which participation
is required by law, rule, or regulation of the jurisdiction in which the pool
or entity is located. |
| (4) |
The reinsurance
is ceded to an assuming insurer that maintains a trust fund in a qualified
United States financial institution, as defined in section 3901.63 of the Revised
Code, for the payment of the valid claims of its United States policyholders
and ceding insurers, and their assigns and successors in interest
in accordance with division (C) of this
section. |
| (5) |
The reinsurance is ceded to an assuming insurer that has
been certified by the superintendent as a reinsurer in this state and that
secures its obligations in accordance with division (D) of this
section. |
|
| (B) |
| (1) |
In order to be eligible for accreditation under
division (A)(2) of this section, the assuming insurer shall do all of the
following:
| (a) |
File with the
superintendent evidence of its submission to this state's jurisdiction; |
| (b) |
Submit to this state's
authority to examine its books and records; |
| (c) |
Maintain a license to transact insurance or
reinsurance in at least one state or, in the case of a United States branch of
a foreign or alien assuming insurer, be entered through and licensed to
transact insurance or reinsurance in at least one state; |
| (d) |
File annually with the superintendent a copy of its
annual statement filed with the insurance department of its state of domicile,
and a copy of its most recent audited financial statement; |
| (e) |
Demonstrate to the satisfaction of the superintendent
that it has adequate financial capacity to meet its reinsurance obligations and
is otherwise qualified to assume reinsurance from domestic insurers. |
|
| (2) |
An assuming insurer is
considered to meet the requirement of division (B)(1)(e) of this section as of
the time of its application to the superintendent for accreditation if it
maintains a surplus with regard to policyholders in an amount not less than
twenty million dollars, and the superintendent has not denied its accreditation
within ninety days after submission of its application. |
|
| (C) |
| (1) |
A trust maintained by an assuming insurer under
division (A)(4) of this section shall meet the following
requirements:
| (a) |
In the case of a
single assuming insurer, the trust shall consist of a trusteed account
representing the assuming insurer's liabilities attributable to business
underwritten in the United States. A trusteed surplus of not less than twenty
million dollars shall be maintained by the assuming insurer, except that at any time after the assuming insurer has
permanently discontinued underwriting new business secured by the trust for at
least three full years, the superintendent with principal regulatory oversight
of the trust may authorize a reduction in the required trusteed surplus, but
only after a finding, based on an assessment of the risk, that the new required
surplus level is adequate for the protection of ceding insurers within the
United States, policyholders, and claimants in light of reasonably foreseeable
adverse loss development. The risk assessment may involve an actuarial review,
including an independent analysis of reserves and cash flows, and shall
consider all material risk factors, including when applicable the lines of
business involved, the stability of the incurred loss estimates, and the effect
of the surplus requirements on the assuming insurer's liquidity or
solvency. The minimum required trusteed surplus shall not be reduced
to an amount less than thirty per cent of the assuming insurer's liabilities
attributable to reinsurance ceded by ceding insurers within the United States
covered by the trust.
|
| (b) |
In the case of a
group of assuming insurers, including incorporated and individual
unincorporated underwriters, the trust shall consist of a trusteed account
representing the group's liabilities attributable to business written in the
United States. A trusteed surplus shall be maintained by the group, of which
surplus one hundred million dollars shall be held jointly for the benefit of
the United States ceding insurers of any member of the group. The following
requirements apply to the group of assuming insurers:
| (i) |
The incorporated
members of the group shall not engage in any business other than underwriting
as a member of the group, and shall be subject to the same level of solvency
regulation and control by the group's domiciliary regulator as are the
unincorporated members. |
| (ii) |
The group shall
make available to the superintendent of insurance an annual certification of
the solvency of each underwriter in the group. The certification shall be
provided by the group's domiciliary regulator and its independent public
accountants. |
|
| (c) |
In the case of a
group of incorporated insurers under common administration with aggregate
policyholders' surplus of ten billion dollars that has continuously transacted
an insurance business outside the United States for at least three years
immediately prior to assuming reinsurance, the trust shall be in an amount
equal to the group's several liabilities attributable to business ceded by
United States ceding insurers to any member of the group pursuant to
reinsurance contracts issued in the name of the group. A joint trusteed surplus
shall be maintained by the group, of which surplus one hundred million dollars
shall be held jointly for the benefit of United States ceding insurers of any
member of the group as additional security for any such liabilities. The
following requirements apply to the group of incorporated insurers:
| (i) |
The group shall
comply with all filing requirements contained in this section. |
| (ii) |
The books and
records of the group shall be subject to examination by the superintendent in
the same manner as the books and records of insurers are subject to examination
by the superintendent in accordance with section 3901.07 of the Revised Code.
The group shall bear the expenses of these examinations in the manner provided
by that section. |
| (iii) |
Each member of
the group shall make available to the superintendent an annual certification of
the member's solvency by the member's domiciliary regulator and an independent
public accountant. |
|
|
| (2) |
A trust
maintained by an assuming insurer under division (A)(4) of this
section shall remain in effect for as long as the assuming insurer has
outstanding obligations due under the reinsurance agreements subject to the
trust. The trust shall be in a form approved by the superintendent and shall
include the following:
| (a) |
The trust
instrument shall provide that contested claims are valid and enforceable upon
the final order of any court of competent jurisdiction in the United
States. |
| (b) |
The trust shall
vest legal title to its assets in the trustees of the trust for its United
States policyholders and ceding insurers, and their assigns and successors in
interest. |
| (c) |
The trust, and
the assuming insurer maintaining the trust, shall allow the superintendent to
conduct examinations in the same manner as the superintendent conducts
examinations of insurers under section 3901.07 of the Revised
Code. |
|
| (3) |
No later
than the last day of February of each year, the trustees of a trust maintained
by an assuming insurer under division (A)(4) of this
section shall provide the superintendent with a written report setting forth
the balance of the trust and listing the trust's investments as of the
preceding thirty-first day of December. The trustees shall certify the date of
the termination of the trust, if termination of the trust is planned, or shall
certify that the trust does not expire prior to the following thirty-first day
of December. |
| (4) |
To
enable the superintendent to determine the sufficiency of a trust maintained by
an assuming insurer under division (A)(4) of this
section, the assuming insurer shall annually report information on the trust to
the superintendent that is substantially the same as that information licensed
insurers are required to report under sections 3907.19, 3909.06, and 3929.30 of
the Revised Code on forms adopted under section 3901.77 of the Revised
Code. |
|
| (D) |
| (1) |
In order to be eligible
for certification under division (A)(5) of this section, the assuming insurer
shall do all of the following:
| (a) |
Be domiciled and licensed to transact insurance or
reinsurance in a qualified jurisdiction as determined by the superintendent
pursuant to division (D)(3) of this section; |
| (b) |
Maintain minimum capital and surplus, or its
equivalent, in an amount to be determined by the superintendent in rule or
regulation; |
| (c) |
Maintain financial
strength ratings from two or more rating agencies that meet criteria the
superintendent sets forth in rule or regulation; |
| (d) |
Agree to submit to the jurisdiction of this state,
appoint the superintendent as its agent for service of process in this state,
and agree to provide security for one hundred per cent of the assuming
insurer's liabilities attributable to reinsurance ceded by ceding insurers in
the United States if it resists enforcement of a final judgment from the United
States; |
| (e) |
Agree to meet applicable
information filing requirements as determined by the superintendent with
respect to an initial application for certification and on an ongoing
basis; |
| (f) |
Satisfy any other
requirements for certification considered relevant by the superintendent. |
|
| (2) |
An association, including
incorporated and individual unincorporated underwriters, may be a certified
reinsurer. In order to be eligible for certification, an association, in
addition to satisfying the requirements of division (D)(1) of this section,
shall also meet the following requirements:
| (a) |
The association shall satisfy its minimum capital and
surplus requirements through the capital and surplus equivalents (net of
liabilities), or the net liabilities, of the association and its members which
shall include a joint central fund that may be applied to any unsatisfied
obligation of the association or any of its members, in an amount determined by
the superintendent in order to provide adequate protection. |
| (b) |
The incorporated members of the association shall not
be engaged in any business other than underwriting as a member of the
association, and shall be subject to the same level of regulation and solvency
control by the association's domiciliary regulator as the unincorporated
members. |
| (c) |
The association shall
provide the superintendent an annual certification by the association's
domiciliary regulator of the solvency of each underwriter member within ninety
days after its financial statements are due to be filed with the association's
domiciliary regulator. If a certification is unavailable, the association shall
provide the superintendent with financial statements prepared by independent
public accountants of each underwriter member of the association. |
|
| (3) |
The superintendent shall
create and publish a list of qualified jurisdictions under which an assuming
insurer licensed and domiciled in such jurisdiction is eligible to be
considered by the superintendent for certification as a certified
reinsurer.
| (a) |
The superintendent shall
consider the list of qualified jurisdictions published through the national
association of insurance commissioner's committee process in determining
qualified jurisdictions. If the superintendent approves a jurisdiction as
qualified that does not appear on the list, the superintendent shall provide
justification in accordance with criteria to be developed by the superintendent
under rule or regulation. |
| (b) |
Jurisdictions within the United States that meet the
requirement for accreditation under the national association of insurance
commissioner's financial standards and accreditation program shall be
recognized as qualified. |
| (c) |
To determine if a domiciliary jurisdiction not located
within the United States is eligible to be recognized as a qualified
jurisdiction, the superintendent shall evaluate the appropriateness and
effectiveness of the reinsurance supervisory system of the jurisdiction, both
initially and on an ongoing basis, and consider the rights, benefits, and the
extent of reciprocal recognition afforded by the jurisdiction to reinsurers
licensed and domiciled in the United States. |
| (d) |
A qualified jurisdiction shall agree to share
information and cooperate with the superintendent with respect to all certified
reinsurers domiciled within that jurisdiction. |
| (e) |
A jurisdiction shall not be recognized as a qualified
jurisdiction if the superintendent has determined that the jurisdiction does
not adequately and promptly enforce final judgments and arbitration awards from
the United States. |
| (f) |
If a certified reinsurer's domiciliary jurisdiction
ceases to be a qualified jurisdiction, the superintendent may revoke the
reinsurer's certification or suspend the reinsurer's certification
indefinitely. |
| (g) |
The superintendent may
consider additional factors as the superintendent considers appropriate. |
|
| (4) |
The superintendent shall
assign a rating to each certified reinsurer giving due consideration to the
financial strength ratings assigned by rating agencies pursuant to division
(D)(1)(c) of this section. The superintendent shall publish a list of all
certified reinsurers and their ratings. |
| (5) |
A certified reinsurer shall secure obligations assumed
from a ceding insurer within the United States at a level consistent with its
rating as specified by the superintendent in rule or regulation.
| (a) |
Except as otherwise provided in division (D)(5) of
this section, a certified reinsurer shall maintain security in a form
acceptable to the superintendent and consistent with section 3901.63 of the
Revised Code, or in a multibeneficiary trust on behalf of the ceding insurer in
accordance with division (A)(4) of this section, in order for a domestic ceding
insurer to qualify for full financial statement credit for reinsurance ceded to
a certified reinsurer. |
| (b) |
If a certified reinsurer chooses to secure its
obligations incurred as a certified reinsurer in the form of a multibeneficiary
trust for the benefit of the ceding insurer, the certified reinsurer shall
maintain separate trust accounts for its obligations incurred under reinsurance
agreements issued or renewed as a certified reinsurer with reduced security as
permitted by this division or comparable laws of other jurisdictions within the
United States, and for its obligations subject to division (A)(4) of this
section. |
| (c) |
Upon termination of any
such trust account described in division (A)(4) of this section, a certified
reinsurer shall be bound by the language of the trust and agreement with the
superintendent that has principal regulatory oversight of each trust account to
fund any deficiency of any other trust account out of the remaining surplus of
such trust as a condition to certification under division (D)(1) of this
section. |
| (d) |
The minimum trusteed
surplus requirements provided in division (C) of this section are not
applicable with respect to a multibeneficiary trust maintained by a certified
reinsurer for the purpose of securing obligations incurred under division
(A)(5) of this section, except that such trust shall maintain a minimum
trusteed surplus of ten million dollars. |
| (e) |
With respect to obligations incurred by a certified
reinsurer under division (A)(5) of this section, if the security is
insufficient, the superintendent shall reduce the allowable credit by an amount
proportionate to the deficiency, and the superintendent may impose further
reductions in allowable credit upon finding that there is a material risk that
the certified reinsurer's obligations will not be paid in full when due. |
| (f) |
Except as otherwise
provided in division (D)(5) of this section, a reinsurer whose certification
has been terminated for any reason shall be treated under this section as a
certified reinsurer required to secure one hundred per cent of its obligations.
The superintendent may continue to assign a higher rating to the reinsurer if
the reinsurer is in inactive status or the reinsurer's certification has been
suspended. As used in division (D)(5)(f) of this section, "terminated" means
revocation, suspension, voluntary surrender, or inactive status. |
|
| (6) |
If an applicant for
certification has been certified as a reinsurer in a national association of
insurance commissioners accredited jurisdiction, the superintendent may defer
to that jurisdiction's certification and rating assignment, and the assuming
insurer shall be considered to be a certified reinsurer in this state. |
| (7) |
A certified reinsurer
that ceases to assume new business in this state may request to maintain its
certification in inactive status in order to continue to qualify for a
reduction in security for its in-force business. An inactive certified
reinsurer shall continue to comply with all applicable requirements of division
(A)(5) of this section, and the superintendent shall assign a rating that takes
into account, if relevant, the reasons why the reinsurer is not assuming new
business. |
|
| (E) |
An assuming
insurer shall file a written instrument appointing an attorney as its agent in
this state upon whom all service of process may be served. Service of process
upon this agent shall bring the assuming insurer within the jurisdiction of the
courts of this state as if served upon an agent pursuant to section 3927.03 of
the Revised Code. |
| (F) |
Nothing in this section
shall prohibit the parties to a reinsurance agreement from agreeing to
provisions in the agreement establishing security requirements that exceed the
minimum security requirements established for certified reinsurers under this
section. |
| (G) |
| (1) |
In order to facilitate
the prompt payment of claims, the superintendent may permit a certified
reinsurer to defer the posting of security for catastrophe recoverables for a
period of up to one year from the date of the first instance of a liability
reserve entry by the ceding insurer as a result of a loss from a catastrophic
occurrence. |
| (2) |
Upon notice by the ceding
insurer to the superintendent that the certified reinsurer has failed to pay
claims owed under a reinsurance agreement in a timely manner, the
superintendent shall notify the certified reinsurer that it is no longer
permitted to defer the posting of security for catastrophe recoverables. |
| (3) |
Reinsurance recoverables
for only the following lines of business, as reported on the national
association of insurance commissioners' annual financial statement related
specifically to the catastrophic occurrence, shall be included in the
deferral:
| (c) |
Farmowner's multiple peril; |
| (d) |
Homeowners multiple peril; |
| (e) |
Commercial multiple peril; |
| (h) |
Auto physical damage. |
|
| (4) |
The superintendent may adopt rules in accordance with
Chapter 119. of the Revised Code to establish the process for a certified
reinsurer to seek a deferral of posting of security for catastrophe
recoverables. |
|
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 09-01-2002
.
| (A) |
If a reinsurer accredited
pursuant to division (B)(1) of section 3901.62 of the Revised Code or certified
pursuant to division (D)(1) of that section ceases to meet the requirements for
accreditation or certification, the superintendent may suspend or revoke the
reinsurer's accreditation or certification after a hearing held pursuant to
Chapter 119. of the Revised Code. The suspension or revocation shall not take
effect until after the superintendent's order or hearing, unless one of the
following applies:
| (1) |
The reinsurer waives its
right to a hearing. |
| (2) |
The superintendent's order is based on regulatory
action by the reinsurer's domiciliary jurisdiction or the voluntary surrender
or termination of the reinsurer's eligibility to transact insurance or
reinsurance business in its domiciliary jurisdiction or in the primary
certifying state of the reinsurer under division (D)(6) of section 3901.62 of
the Revised Code. |
| (3) |
The superintendent finds that an emergency requires
immediate action, and a court of competent jurisdiction has not stayed the
superintendent's action. |
|
| (B) |
While a reinsurer's accreditation or certification is
suspended, no reinsurance contract issued or renewed after the effective date
of the suspension qualifies for credit except to the extent that the
reinsurer's obligations under the contract are secured in accordance with
section 3901.63 of the Revised Code. |
| (C) |
If the superintendent revokes a reinsurer's
accreditation or certification, no credit for reinsurance may be granted under
section 3901.62 or 3901.63 of the Revised Code after the effective date of the
revocation except to the extent that the reinsurer's obligations under the
contract are secured in accordance with division (D)(5) of section 3901.62 or
section 3901.63 of the Revised Code. |
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
If section 3901.62 of the Revised Code does not
apply to the reinsurance ceded to an assuming insurer by a domestic ceding
insurer that is authorized to do any insurance business in this state, the
ceding insurer may take credit for the reinsurance ceded as a reduction of
liability in an amount not exceeding the liabilities carried by the ceding
insurer, if the ceding insurer complies with section 3901.64 of the Revised
Code, and if funds are held directly by the ceding insurer or in trust on
behalf of the ceding insurer, in accordance with this section, as security for
the payment of obligations under the reinsurance contract with the assuming
insurer. |
| (B) |
| (1) |
If the funds are held directly by the ceding
insurer under division (A) of this section, the funds shall be held in the
United States and shall be under the exclusive control of, and subject to
withdrawal solely by, the ceding insurer. If the funds are held in trust on
behalf of the ceding insurer under division (A) of this section, the funds
shall be held in the United States in a qualified United States financial
institution. |
| (2) |
For the purposes of division (B)(1) of this
section, a "United States financial institution" is qualified if both of the
following apply:
| (a) |
The
institution is organized under or, in the case of a United States branch or
agency office of a foreign banking organization, is chartered under the laws of
the United States or any state thereof and has been granted authority to
operate with fiduciary powers. |
| (b) |
The
institution is regulated, supervised, and examined by federal or state
officials that have regulatory authority over banks and trust
companies. |
|
|
| (C) |
The funds held directly by the ceding insurer or in trust on behalf of the
ceding insurer shall be in any of the following forms:
| (2) |
Securities
that are listed by the securities valuation office of the national association
of insurance commissioners, including those considered
exempt from filing as defined by the purposes and procedures manual of the
securities valuation office, and that qualify as admitted
assets; |
| (3) |
Irrevocable,
unconditional, and automatically renewable letters of credit that are issued or
confirmed by a qualified United States financial institution. For purposes of
division (C)(3) of this section, a United States financial institution is
qualified if all of the following apply:
| (a) |
It
is organized under or, in the case of a United States branch or agency office
of a foreign banking organization, is chartered under the laws of the United
States or any state thereof. |
| (b) |
It
is regulated, supervised, and examined by federal or state officials that have
regulatory authority over banks and trust companies. |
| (c) |
The
superintendent of insurance or the securities valuation office of the national
association of insurance commissioners has determined that it meets such
standards of financial condition and standing as are considered necessary and
appropriate for purposes of ensuring that its letters of credit will be of a
quality that is acceptable to the superintendent. |
|
| (4) |
Any
other form of security the superintendent determines to be
acceptable. |
|
| (D) |
Notwithstanding any subsequent failure of an
issuing or confirming financial institution to meet the standards of issuer
acceptability set forth in division (C)(3) of this section, a letter of credit
issued or confirmed by a financial institution that meets those standards on
the date of the issuance or confirmation shall continue to be acceptable as
security until its expiration, extension, renewal, modification, or amendment,
whichever occurs first. |
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 06-29-1994
.
| (A) |
A domestic ceding insurer
shall take steps to manage its reinsurance recoverables proportionate to its
own book of business.
| (1) |
A domestic ceding insurer
shall notify the superintendent within thirty days after reinsurance
recoverables from any single assuming insurer, or group of affiliated assuming
insurers, exceed fifty per cent of the domestic ceding insurer's last reported
surplus to policyholders, or after it has determined that reinsurance
recoverables from any single assuming insurer, or group of affiliated assuming
insurers, are likely to exceed this limit. |
| (2) |
The notification required in division (A)(1) of this
section shall demonstrate that the exposure is safely managed by the domestic
ceding insurer. |
|
| (B) |
A domestic ceding insurer shall take steps to
diversify its reinsurance program.
| (1) |
A domestic ceding insurer shall notify the
superintendent within thirty days after ceding to any single assuming insurer,
or group of affiliated assuming insurers, more than twenty per cent of the
ceding insurer's gross written premium in the prior calendar year, or after it
has determined that the reinsurance ceded to any single assuming insurer, or
group of affiliated assuming insurers, is likely to exceed this limit. |
| (2) |
The notification required
in division (B)(1) of this section shall demonstrate that the exposure is
safely managed by the domestic ceding insurer. |
|
Added by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
| (A) |
A domestic ceding insurer may take credit for any
reinsurance ceded as provided in sections 3901.61 to 3901.63 of the Revised
Code only if the reinsurance agreement contained in the reinsurance contract,
and any agreement that provides security for the payment of the obligations
under the reinsurance agreement, including any trust agreement, provide, in
substance, for the following:
| (1) |
In the event
of the insolvency of the ceding insurer, the reinsurance, whether paid directly
or from trust assets securing the reinsurance agreement, shall be payable by
the assuming insurer on the basis of the liability of the ceding insurer under
the policy or contract reinsured, without any diminution because the ceding
insurer is insolvent or because the liquidator or statutory receiver has failed
to pay all or any portion of any claims; |
| (2) |
The
reinsurance payments, whether paid directly or from trust assets securing the
reinsurance agreement, shall be made by the assuming insurer directly to the
ceding insurer, or in the event of its insolvency or liquidation, to its
liquidator or statutory receiver except where the reinsurance contract or other
written agreement specifically provides for direct payment of the reinsurance
to the insured or beneficiary of the insurance policy in the event of the
insolvency of the ceding insurer. |
|
| (B) |
| (1) |
The reinsurance agreement may provide that the domiciliary liquidator or
statutory receiver shall give written notice to the assuming insurer that a
claim is pending against the ceding insurer on the policy or contract
reinsured. The notice shall be given within a reasonable amount of time after
the claim is filed with the liquidator or statutory receiver. During the
pendency of the claim, any assuming insurer may investigate the claim and
interpose, at its own expense, in the proceeding where the claim is to be
adjudicated any defenses which it deems to be available to the ceding insurer
or its liquidator. |
| (2) |
The expense may be filed as a claim against the
insolvent ceding insurer to the extent of a proportionate share of the benefit
that may accrue to the ceding insurer solely as a result of the defense
undertaken by the assuming insurer. Where two or more assuming insurers are
involved in the same claim and a majority in interest elect to interpose a
defense to the claim, the expense shall be apportioned in accordance with the
terms of the reinsurance agreement as though the expense had been incurred by
the ceding insurer. |
|
| (C) |
If the assuming insurer is not licensed, or accredited
or certified to transact insurance or reinsurance in this state, the credit
permitted by division (A)(4) of section 3901.62 of the Revised Code shall not
be allowed unless the assuming insurer agrees to do both of the following in
the reinsurance agreements:
| (1) |
| (a) |
If the assuming insurer fails to perform its
obligations under the terms of the reinsurance agreement, at the request of the
ceding insurer, the assuming insurer shall submit to the jurisdiction of any
court of competent jurisdiction in any state within the United States, comply
with all requirements necessary to give the court jurisdiction, and abide by
the final decision of the court or of any appellate court in the event of an
appeal. |
| (b) |
The assuming insurer
shall designate the superintendent or a designated attorney as its true and
lawful attorney upon whom may be served any lawful process in any action, suit,
or proceeding instituted by or on behalf of the ceding insurer. |
|
| (2) |
This division is not
intended to conflict with or override the obligation of the parties to a
reinsurance agreement to arbitrate their disputes, if this obligation is
created in the agreement. |
|
| (D) |
If the assuming insurer does not meet the requirements
of division (A)(1), (2), or (3) of section 3901.62 of the Revised Code, the
credit permitted by divisions (A)(4) and (5) of that section shall not be
allowed unless the assuming insurer agrees in the trust agreements to the
following conditions:
| (1) |
Notwithstanding any other
provisions in the trust instrument, if the trust fund is inadequate because it
contains an amount less than the amount required by division (C)(1) of section
3901.62 of the Revised Code, or if the grantor of the trust has been declared
insolvent or placed into receivership, rehabilitation, liquidation, or similar
proceedings under the laws of its state or country of domicile, the trustee
shall comply with an order of the superintendent with regulatory oversight over
the trust or with an order of a court of competent jurisdiction directing the
trustee to transfer to the superintendent with regulatory oversight all of the
assets of the trust fund. |
| (2) |
The assets shall be distributed by, and claims shall
be filed with and valued by, the superintendent with regulatory oversight in
accordance with the laws of the state, in which the trust is domiciled, that
are applicable to the liquidation of domestic insurance companies. |
| (3) |
If the superintendent
with regulatory oversight determines that the assets of the trust fund, or any
part thereof, are not necessary to satisfy the claims of the ceding insurers
within the United States or the grantor of the trust, the superintendent with
regulatory oversight shall return the assets or part thereof to the trustee for
distribution in accordance with the trust agreement. |
| (4) |
The grantor shall waive any right otherwise available
to it under the laws of the United States that are inconsistent with this
division. |
|
Amended by
130th General Assembly File No. TBD, SB 140, §1,
eff. 9/4/2014.
Effective Date: 10-31-2001
.
The superintendent of insurance may adopt rules, in accordance
with Chapter 119. of the Revised Code, to carry out the purposes of sections
3901.61 to 3901.65 of the Revised
Code, including a rule regarding the standards of acceptability of letters of
credit and other forms of security for purposes of division (C) of section
3901.63 of the Revised Code.
Effective Date:
06-29-1994 .
As used in sections 3901.67 to
3901.70 of the Revised Code:
| (A) |
"Material acquisition" means an
acquisition, or a series of related acquisitions during any thirty-day period,
that is nonrecurring and not in the ordinary course of business and involves
more than five per cent of the reporting insurer's total admitted assets as
reported in its most recent statutory financial statement filed with the
department of insurance. |
| (B) |
"Material disposition" means a disposition, or a series of related dispositions
during any thirty-day period, that is nonrecurring and not in the ordinary
course of business and involves more than five per cent of the reporting
insurer's total admitted assets as reported in its most recent statutory
financial statement filed with the department of insurance. |
| (C) |
"Material nonrenewal, cancellation, or
revision of ceded reinsurance agreements" means a nonrenewal, cancellation, or
revision of ceded insurance that affects more than fifty per cent of an
insurer's ceded written premium, or more than fifty per cent of an insurer's
total ceded indemnity and loss adjustment reserves, for property and casualty
business, including accident and health business when written as such.
"Material nonrenewal, cancellation, or revision of ceded reinsurance
agreements" also means a nonrenewal, cancellation, or revision of ceded
insurance that affects more than fifty per cent of the total reserve credit
taken for business ceded for life, annuity, and accident and health business,
where the ceded written premium or total reserve credit taken is calculated on
an annualized basis as indicated in the insurer's most recently filed statutory
financial statement. A nonrenewal, cancellation, or revision of ceded insurance is
not material for property and casualty business, including accident and health
business when written as such, if the insurer's total ceded written premium
represents, on an annualized basis, less than ten per cent of its total written
premium for direct and assumed business. A nonrenewal, cancellation, or
revision of ceded insurance is not material for life, annuity, and accident and
health business, if the total reserve credit taken for business ceded
represents less than ten per cent of the statutory reserve requirements prior
to any cession.
|
Effective Date:
03-03-1996 .
Sections
3901.67 to
3901.70 of the Revised Code apply
to all of the following:
| (A) |
Asset
acquisitions, including every purchase, lease, exchange, merger, consolidation,
succession, or other acquisition other than the construction or development of
real property by or for the reporting insurer, or the acquisition of materials
for such purpose. |
| (B) |
Asset
dispositions, including every sale, lease, exchange, merger, consolidation,
mortgage, hypothecation, assignment whether for the benefit of creditors or
otherwise, abandonment, destruction, or other disposition. |
| (C) |
Nonrenewals, cancellations, or revisions of ceded
reinsurance, without regard to which party has initiated the transaction,
whenever one or more of the following conditions exists:
| (1) |
The entire cession has been canceled, and
nonrenewed or revised and ceded indemnity and loss adjustment expense reserves
after any nonrenewal, cancellation, or revision represents less than fifty per
cent of the comparable reserves that would have been ceded had the nonrenewal,
cancellation, or revision not occurred. |
| (2) |
An authorized reinsurer has been replaced
on an existing cession by an unauthorized reinsurer, and the revision affects
more than ten per cent of the cession. |
| (3) |
Collateral requirements previously
established for unauthorized reinsurers have been reduced, and the revision
affects more than ten per cent of the cession. |
|
Effective Date:
03-03-1996 .
| (A) |
Each
insurer domiciled in this state shall file a report with the superintendent of
insurance disclosing material acquisitions and material dispositions of assets,
and material nonrenewals, cancellations, or revisions of ceded reinsurance
agreements, unless such transactions previously have been reported to the
superintendent for review, approval, or information purposes, pursuant to
another provision of Title XXXIX [39] of the Revised Code. The report shall be
in the form prescribed by the superintendent by rule. One complete copy of the
report, including any exhibits and attachments, shall be filed with the
superintendent within fifteen days after the end of the calendar month in which
any of the transactions occurs. |
| (B) |
Each report of a material acquisition or
disposition of assets shall include the following information:
| (1) |
The date of the transaction; |
| (2) |
The manner of acquisition or disposition;
|
| (3) |
A description of the assets
involved; |
| (4) |
The nature and amount
of the consideration given or received; |
| (5) |
The purpose of, or reason for, the
transaction; |
| (6) |
The manner by
which the amount of consideration was determined; |
| (7) |
The gain or loss recognized or realized
as a result of the transaction; |
| (8) |
The names of the person or persons from whom the assets were acquired or to
whom they were disposed. |
|
| (C) |
Each insurer shall report material acquisitions
and material dispositions on a nonconsolidated basis, unless the insurer is
part of a consolidated group of insurers that utilizes a pooling arrangement or
a one hundred per cent reinsurance agreement that affects the solvency and
integrity of the insurer's reserves and the insurer has ceded substantially all
of its direct and assumed business to the pool. The insurer is deemed to have
ceded substantially all of its direct and assumed business to the pool if both
of the following apply:
| (1) |
The insurer has
less than one million dollars total direct plus assumed written premiums during
a calendar year that are not subject to the pooling arrangement; |
| (2) |
The net income of the insurer that is not
subject to the pooling arrangement represents less than five per cent of the
insurer's capital and surplus. |
|
| (D) |
Each report of a material nonrenewal,
cancellation, or revision of ceded reinsurance agreements shall include the
following information:
| (1) |
The effective date
of the nonrenewal, cancellation, or revision; |
| (2) |
A description of the transaction;
|
| (3) |
The purpose of, or reason for,
the transaction; |
| (4) |
If applicable,
the identity of the replacement reinsurers; |
| (5) |
The identity of the person initiating the
transaction. |
|
| (E) |
Each
insurer shall report all material nonrenewals, cancellations, or revisions of
ceded reinsurance agreements on a nonconsolidated basis, unless the insurer is
part of a consolidated group of insurers that utilizes a pooling arrangement or
a one hundred per cent reinsurance agreement that affects the solvency and
integrity of the insurer's reserves and the insurer has ceded substantially all
of its direct and assumed business to the pool. The insurer is deemed to have
ceded substantially all of its direct and assumed business to the pool if both
of the following apply:
| (1) |
The insurer has
less than one million dollars total direct plus assumed written premiums during
a calendar year that are not subject to the pooling arrangement; |
| (2) |
The net income of the insurer that is not
subject to the pooling arrangement represents less than five per cent of the
insurer's capital and surplus. |
|
Effective Date:
03-03-1996 .
| (A) |
Each
report obtained by or disclosed to the superintendent of insurance pursuant to
sections 3901.67 to 3901.70 of the Revised
Code is confidential and privileged and is not subject to subpoena. Except as
provided in division (B) of this section, the report shall not be made public
by the superintendent or any other persons. |
| (B) |
Notwithstanding division (A) of this section, the
superintendent may do any of the following:
| (1) |
Disclose a report that is the subject of
this section upon obtaining a prior written consent from the insurer to which
the report pertains; |
| (2) |
Share a
report that is the subject of this section with the chief deputy rehabilitator,
the chief deputy liquidator, other deputy rehabilitators and liquidators, and
any other person employed by, or acting on behalf of, the superintendent
pursuant to Chapter 3901. or 3903. of the Revised Code, with other local,
state, federal, and international regulatory and law enforcement agencies, with
local, state, and federal prosecutors, and with the national association of
insurance commissioners and its affiliates and subsidiaries, provided that the
recipient agrees to maintain the confidential or privileged status of the
confidential or privileged report and has authority to do so; |
| (3) |
Disclose a report that is the subject of
this section in the furtherance of any regulatory or legal action brought by or
on behalf of the superintendent or the state, resulting from the exercise of
the superintendent's official duties; |
| (4) |
Disclose or publish all or any part of a
report that is the subject of this section in such a manner as the
superintendent considers appropriate after conducting a hearing in accordance
with Chapter 119. of the Revised Code and determining that the interests of
policyholders, shareholders, or the public will be served by the disclosure or
publication of the report. |
|
| (C) |
Notwithstanding divisions (A) and (B) of this
section, the superintendent may authorize the national association of insurance
commissioners and its affiliates and subsidiaries by agreement to share
confidential or privileged reports received pursuant to division (B)(2) of this
section with local, state, federal, and international regulatory and law
enforcement agencies and with local, state, and federal prosecutors, provided
that the recipient agrees to maintain the confidential or privileged status of
the confidential or privileged report and has authority to do so. |
| (D) |
Notwithstanding divisions (A) and (B) of
this section, the chief deputy rehabilitator, the chief deputy liquidator, and
other deputy rehabilitators and liquidators may disclose a report that is the
subject of this section in the furtherance of any regulatory or legal action
brought by or on behalf of the superintendent, the rehabilitator, the
liquidator, or the state resulting from the exercise of the superintendent's
official duties in any capacity. |
| (E) |
Nothing in this section shall prohibit the
superintendent from receiving reports in accordance with section
3901.045 of the Revised Code.
|
| (F) |
The superintendent may enter
into agreements governing the sharing, use, and disclosure of reports
consistent with the requirements of this section. |
| (G) |
| (1) |
No waiver
of any applicable privilege or claim of confidentiality in the reports that are
the subject of this section shall occur as a result of sharing or receiving
reports as authorized in divisions (B)(2), (C), and (E) of this section.
|
| (2) |
The disclosure of a report in
connection with a regulatory or legal action pursuant to divisions (B)(3) and
(D) of this section does not prohibit an insurer or any other person from
taking steps to limit the dissemination of the report to persons not involved
in or the subject of the regulatory or legal action on the basis of any
recognized privilege arising under any other section of the Revised Code or the
common law. |
|
Effective Date:
06-18-2002 .
| (A) |
As used in
this section, "mandated health benefits" means any required coverage, or
required offering of coverage, for the expenses of specified services,
treatments, or diseases under any policy, contract, plan, or other arrangement
providing sickness and accident or other health benefits to policyholders,
subscribers, or members. |
| (B) |
Any
provision for mandated health benefits contained in a law enacted by the
general assembly after January 14, 1993, shall not be applied to any policy,
contract, plan, or other arrangement providing sickness and accident or other
health benefits until the superintendent of insurance determines, pursuant to a
hearing conducted in accordance with Chapter 119. of the Revised Code, that the
provision can be applied fully and equally in all respects to employee benefit
plans subject to regulation by the federal "Employee Retirement Income Security
Act of 1974," 88 Stat. 832, 29 U.S.C.A. 1001, as amended, and
to employee benefit plans established or modified by the state or any political
subdivision of the state, or by any agency or instrumentality of the state or
any political subdivision of the state. |
Effective Date:
11-24-1995 .
Any person may advance to a domestic insurance company or a
health insuring corporation any sum of money necessary for the purpose of the
insurance company's or health insuring corporation's business, or to enable the
insurance company or health insuring corporation to comply with any law, or as
a cash guarantee fund. Such money, and interest agreed upon, shall not be a
liability or claim against the insurance company or health insuring
corporation, or any of its assets, except as provided in this section, and
shall be repaid only out of the surplus earnings of such insurance company or
health insuring corporation. Except as ordered by the superintendent of
insurance, no part of the principal or interest thereof shall be repaid until
the surplus of the insurance company or health insuring corporation remaining
after such repayment is equal in amount to the principal of the money so
advanced. Such advancement and repayment shall be subject to the approval of
the superintendent, provided that this section shall not affect the power to
borrow money which any such insurance company or health insuring corporation
possesses under other laws. No commission or promotion expenses shall be paid
by the insurance company or health insuring corporation, in connection with the
advance of any such money to the insurance company or health insuring
corporation, and the amount of any such unpaid advance shall be reported in
each annual statement.
Effective Date:
09-26-2003 .
The department of insurance shall forward a copy of any written
notice received from any insurance company or health insuring corporation
domiciled in this state that the insurer or health insuring corporation will be
late in making the filing of any quarterly or annual financial statement,
required under Title XXXIX [39] or Chapter 1751. of the Revised Code, to the
board of directors of the insurer or health insuring corporation required to
file the financial statement. The department shall also provide the board the
date on which the department received the notice.
Effective Date:
06-18-2002 .
When a life insurance company doing business in this state
decides to discontinue its business, the superintendent of insurance upon the
application of the company or association shall give notice, at its expense, of
such intention at least once a week for six weeks in a newspaper published and
of general circulation in the county in which the company or its general agency
is located. After such publication, the superintendent shall deliver to the
company or association its securities held by the superintendent, if the
superintendent is satisfied on an exhibition of its books and papers, and on an
examination made by the superintendent or by some competent, disinterested
person appointed by the superintendent, and upon the oath of the president or
principal officer and the secretary or actuary of the company, that all debts
and liabilities due or to become due upon any contract or agreement made with
any citizen or resident of the United States are paid and extinguished. The
superintendent may deliver to the company or association or its assigns any
portion of the securities on being satisfied that an equal proportion of the
debts and liabilities due or to become due upon any such contract or agreement
have been satisfied, if the amount of securities retained by the superintendent
is not less than twice the amount of the remaining liabilities.
Effective Date:
09-01-2002 .
When any insurance company or corporation other than life,
which company or corporation has made a deposit with the superintendent of
insurance, intends to discontinue its business in this state, the
superintendent, upon the application of the company or corporation, shall give
notice at its expense of such intention at least once a week for six weeks in
three newspapers of general circulation in the state.
After such publication, the superintendent shall deliver to the
company or association its securities held by the superintendent, if the
superintendent is satisfied by the affidavits of the principal officers of the
company, and on an examination made by the superintendent or by some competent,
disinterested person appointed by the superintendent if the superintendent
deems it necessary, that all liabilities and obligations which the deposit has
been made to secure have been paid and extinguished. The superintendent may
deliver to the company or its assigns, under like condition, any portion of the
securities on being satisfied that an equal proportion of the liabilities and
obligations have been satisfied, if the amount of securities retained by the
superintendent is not less than twice the amount of the remaining liabilities
and obligations.
Effective Date:
09-01-2002 .
As used in this section, "securities" means the stocks, bonds,
debentures, and other assets subject from time to time to valuation by the
committee on valuation of securities of the national association of insurance
commissioners.
For the purpose of enabling the superintendent of insurance to
secure the analyses, reports, and information developed by the committee on
valuation of securities of the national association of insurance commissioners
and to pay for such information by cooperating with other states in defraying
the expenses of the committee in the investigation, analysis, and valuation of
securities and the determination of amortizability of bonds owned by life
insurance companies for the purpose of furnishing to the several states on a
uniform basis the information needed in the supervision of insurance companies
licensed to transact business in the several states, there is hereby created in
the state treasury the security valuation expense fund.
The superintendent may collect and disburse, in cooperation
with supervisory officials of other states, the moneys obtained through
assessments as provided in this section. All moneys which are paid into the
fund shall be used only for the purpose of this section.
The superintendent may contract with the committee to make
available to the department of insurance the analyses, reports, and information
developed by the committee and, after taking into consideration similar
payments that may be made by other states, may make payment to the committee to
the extent authorized by this section, on account of the expenses of the
committee, from the fund.
The superintendent shall periodically obtain from the committee
a verified budget estimate of the receipts and of the expenses to be incurred
by the committee for a stated period, not exceeding one year, with appropriate
explanations of the estimates therein contained.
If the superintendent is satisfied as to the reasonableness of
the budget estimate, the superintendent shall determine the portion of the
moneys required by the budget estimate, to be assessed as provided in this
section, by deducting from the budget estimate or from the sum of two hundred
fifty thousand dollars, whichever is less, any amounts received or receivable
by the committee from states with laws that do not substantially conform to the
method of assessment provided in this section and applying to the remainder the
proportion that the total investments in securities of domestic life insurers
bear to the total investments in securities of life insurers domiciled in this
and other states with laws that authorize and require assessments on
substantially the same basis as provided in this section. The superintendent
shall thereafter, as soon as convenient, by notice stating the method of
computation thereof, assess the amount to be paid on account of such expenses,
pro rata upon all domestic life insurers in the proportion that the total
investments in securities of each domestic life insurer bear to the total
investments in securities of all domestic life insurers. The total investments
in securities of any life insurer for purposes of this section shall be the
total admitted value of the securities reported as such in its annual statement
last filed prior to such assessment with the department or with the supervisory
officials of its state of domicile. Upon receipt of the notice each domestic
life insurance company shall within thirty days thereafter pay the amount of
the assessment to the superintendent, who shall deposit the amount in the state
treasury to the credit of the fund. The superintendent shall make such
disbursements from the fund in amounts and at the times determined by the
superintendent under the superintendent's contract with the committee.
The superintendent shall require annually, and at such other
times as the superintendent considers necessary or advisable, a duly certified
audit of receipts and disbursements and statement of assets and liabilities,
showing the details of the financial operations of the committee.
Effective Date:
09-01-2002 .
| (A) |
The
superintendent of insurance shall adopt the forms, instructions, and manuals
prescribed by the national association of insurance commissioners, for the
preparation and filing of statutory financial statements and other financial
information. However, the superintendent may by rule adopt modifications to the
prescribed forms, instructions, and manuals as the superintendent considers
necessary. |
| (B) |
For circumstances
not addressed by the forms, instructions, and manuals prescribed by the
national association of insurance commissioners, the superintendent may
determine accounting practices and methods for purposes of preparing statutory
financial statements and other financial information. |
| (C) |
The superintendent shall furnish each domestic
insurance company the forms for the filing of statutory financial statements
and other financial information required to be made by it. |
Effective Date:
09-01-2002 .
Upon request or in any other circumstance that the
superintendent of insurance determines to be appropriate, the superintendent
may issue certificates of compliance to insurance companies and associations
authorized to do business in this state, which shall be on either forms
established by the national association of insurance commissioners or on such
other forms as the superintendent may prescribe.
Effective Date:
07-02-2004;
09-29-2005 .
Effective Date:
09-29-2005 .
Effective Date:
09-29-2005 .
Effective Date:
09-29-2005 .
Effective Date:
09-29-2005 .
Repealed by
129th General AssemblyFile No.48, HB 218,
§2, eff.
12/26/2011.
Effective Date: 05-01-2000
.
As used in this section and sections 3901.811 to 3901.815 of the Revised
Code:
| (A) |
"Auditing entity" means
any person or government entity that performs a pharmacy audit, including a
payer, a pharmacy benefit manager, or a third-party administrator licensed
under Chapter 3959. of the Revised Code. |
| (B) |
"Business day" means any day of the week excluding
Saturday, Sunday, and a legal holiday, as defined in section
1.14 of the Revised Code. |
| (C) |
"Concurrent review" means
a claims review within five business days of submission of claims for payment
for the provision of dangerous drugs for which the payer or the auditing entity
does not impose a penalty or demand to recoup money from the pharmacy in any
amount. |
| (D) |
"Dangerous drug,"
"pharmacy," "practice of pharmacy," and "prescription" have the same meanings
as in section 4729.01 of the Revised
Code. |
| (E) |
"Payer" means any of the
following that pays for or processes a claim for payment for the provision of
dangerous drugs or pharmacy services:
| (1) |
A health insuring corporation, as defined in section
1751.01 of the Revised
Code; |
| (2) |
A person authorized to
engage in the business of sickness and accident insurance under Title XXXIX of
the Revised Code; |
| (3) |
A person or government entity providing coverage of
dangerous drugs or pharmacy services to individuals on a self-insurance
basis; |
| (4) |
A group health plan, as
defined in 29 U.S.C. 1167; |
| (5) |
A service benefit plan, as referenced in
42 U.S.C. 1396a (a)(25); |
| (6) |
A medicaid managed care organization that has entered
into a contract with the department of medicaid pursuant to section
5167.10 of the Revised
Code; |
| (7) |
Any other person or
government entity that is, by law, contract, or agreement, responsible for
paying for or processing a claim for payment for the provision of dangerous
drugs or pharmacy services. |
|
| (F) |
"Pharmacy audit" means a review of one or more
pharmacy records conducted by an auditing entity, one purpose of which is to
identify discrepancies in claims for payment for the provision of dangerous
drugs or pharmacy services. "Pharmacy audit" does not include concurrent
review. |
| (G) |
"Pharmacy benefit
manager" means a person that provides administrative services related to the
processing of claims for payment for the provision of dangerous drugs or
pharmacy services, including performing pharmacy audit compliance, negotiating
pharmaceutical rebate agreements, developing and managing drug formularies and
preferred drug lists, and administering programs for payers' prior
authorization of claims for payment for the provision of dangerous drugs or
pharmacy services. |
| (H) |
"Pharmacy record" means any record stored
electronically or as a hard copy by a pharmacy that relates to the provision of
dangerous drugs or pharmacy services or any other component of pharmacist care
that is included in the practice of pharmacy. |
Added by
130th General Assembly File No. TBD, SB 258, §1,
eff. 3/23/2015.
| (A) |
Except as
provided in division (B) of this section, an auditing entity is subject to all
of the following conditions when performing a pharmacy audit in this state:
| (1) |
If
it is necessary that the pharmacy audit be performed on the premises of a
pharmacy, the auditing entity shall give the pharmacy that is the subject of
the audit written notice of the date or dates on which the audit will be
performed and the range of prescription numbers from which the auditing entity
will select pharmacy records to audit. Notice of the date or dates on which the
audit will be performed shall be given not less than ten business days before
the date the audit is to commence. Notice of the range of prescription numbers
from which the auditing entity will select pharmacy records to audit shall be
received by the pharmacy not less than seven business days before the date
the audit is to commence. |
| (2) |
The
auditing entity shall not include in the pharmacy audit a review of a claim for
payment for the provision of dangerous drugs or pharmacy services if the date
of the pharmacy's initial submission of the claim for payment occurred more
than twenty-four months before the date the audit commences. |
| (3) |
Absent an indication that there was an error in the dispensing of a drug, the
auditing entity or payer shall not seek to recoup from the pharmacy that is the
subject of the audit any amount that the pharmacy audit identifies as being the
result of clerical or recordkeeping errors in the absence of financial harm.
For purposes of this provision, an error in the dispensing of a drug is any of
the following: selecting an incorrect drug, issuing incorrect directions, or
dispensing a drug to the incorrect patient. |
| (4) |
The
auditing entity shall not use the accounting practice of extrapolation when
calculating a monetary penalty to be imposed or amount to be recouped as the
result of the pharmacy audit. |
|
| (B) |
| (1) |
The
condition in division (A)(1) of this section does not apply if, prior to the
audit, the auditing entity has evidence, from its review of claims data,
statements, or physical evidence or its use of other investigative methods,
indicating that fraud or other intentional or willful misrepresentation
exists. |
| (2) |
The
condition in division (A)(3) of this section does not apply if the auditing
entity has evidence, from its review of claims data, statements, or physical
evidence or its use of other investigative methods, indicating that fraud or
other intentional or willful misrepresentation exists. |
| (3) |
Division (A)(4) of this section does not apply when the accounting practice of
extrapolation is required by state or federal law. |
|
Amended by
133rd General Assembly File No. TBD, HB 339, §1,
eff. 1/1/2021.
Added by
130th General Assembly File No. TBD, SB 258, §1,
eff. 3/23/2015.
A pharmacy may do any of the following when a pharmacy audit is
performed:
| (A) |
Validate a pharmacy
record by using original or photocopied records from hospitals, physicians, or
other health care providers; |
| (B) |
Validate one or more claims for payment for the
provision of dangerous drugs or pharmacy services by using either of the
following:
| (1) |
An original pharmacy
record or photocopy of the record; |
| (2) |
An original prescription or photocopy of the
prescription in any form that constitutes a valid prescription in this state,
including a written prescription, a prescription made through an electronic
prescribing system, a prescription delivered by facsimile, a prescription made
by issuing an order for medication administration, and the record a pharmacist
maintains under section
4729.37 of the Revised Code
documenting a prescription received by telephone. |
|
| (C) |
Resubmit a disputed or denied claim for payment using
any commercially reasonable method of resubmission, including resubmission by
facsimile, mail, or electronic means, as long as the time period for
resubmissions established by the relevant payer has not expired. |
Added by
130th General Assembly File No. TBD, SB 258, §1,
eff. 3/23/2015.
| (A) |
Except as provided in
division (B) of this section, all of the following apply after a pharmacy audit
is completed:
| (1) |
A pharmacy shall be given
not less than thirty days from the date of the on-site audit to provide the
auditing entity any additional information necessary to complete the
preliminary audit report. |
| (2) |
Not later than sixty business days after the audit is
completed, the auditing entity shall deliver a preliminary audit report to the
pharmacy that was the subject of the audit. |
| (3) |
A pharmacy that disputes any finding in the
preliminary audit report may submit documentation to the auditing entity to
appeal the finding. A pharmacy shall be given not less than thirty business
days to make the submission and may request an extension of the time period
given. The auditing entity shall grant a request for an extension if it is
reasonable. A pharmacy's submission of documentation to appeal the
finding shall be made in accordance with the procedure the auditing entity has
established under section 3901.814 of the Revised Code.
|
| (4) |
| (a) |
An auditing entity shall
deliver a final audit report to the pharmacy that was the subject of the audit.
Except as provided in division (A)(4)(b) of this section, the report shall be
delivered not later than one hundred twenty business days after the pharmacy's
receipt of a preliminary audit report. |
| (b) |
If an auditing entity has granted a pharmacy's request
for an extension of the time to submit documentation to appeal a finding in the
preliminary audit report under division (A)(3) of this section, the time limit
described in division (A)(4)(a) of this section for the delivery of the final
audit report is waived. Instead, the auditing entity shall deliver the final
audit report not later than one hundred twenty days after the pharmacy's
submission of the documentation. |
|
|
| (B) |
The provisions of division (A) of this section do not
apply if the auditing entity has evidence, from its review of claims data,
statements, or physical evidence or its use of other investigative methods,
indicating that fraud or other intentional or willful misrepresentation
exists. |
Added by
130th General Assembly File No. TBD, SB 258, §1,
eff. 3/23/2015.
Each auditing entity in this state shall establish in writing separate
procedures for a pharmacy to appeal one or more findings in a preliminary audit
report issued under section 3901.813 of the Revised Code.
Added by
130th General Assembly File No. TBD, SB 258, §1,
eff. 3/23/2015.
Sections 3901.811 to 3901.814 of the Revised Code shall not apply to an
auditing entity that is a medicaid managed care organization if application of
those sections to the entity would be in violation of federal law.
Added by
130th General Assembly File No. TBD, SB 258, §1,
eff. 3/23/2015.
The "Restatement of the Law, Liability Insurance" that was
approved at the 2018 annual meeting of the American law institute does not
constitute the public policy of this state and is not an appropriate subject of
notice.
Added by
132nd General Assembly File No. TBD, SB 239, §1,
eff.
10/29/2018.
As used in sections
3901.83 to 3901.833 of
the Revised Code:
| (A) |
"Clinical practice guidelines" means a systematically
developed statement to assist health care provider and patient decisions with
regard to appropriate health care for specific clinical circumstances and
conditions. |
| (B) |
"Clinical review criteria" means the written screening
procedures, decision abstracts, clinical protocols, and clinical practice
guidelines used by a health plan issuer or utilization review organization to
determine whether or not health care services or drugs are appropriate and
consistent with medical or scientific evidence. |
| (C) |
"Health benefit plan" and "health plan issuer" have
the same meanings as in section
3922.01 of the
Revised Code. |
| (D) |
"Medical or scientific evidence" has the same meaning
as in section
3922.01 of the
Revised Code. |
| (E) |
"Step therapy exemption" means an overriding of a step
therapy protocol in favor of immediate coverage of the health care provider's
selected prescription drug. |
| (F) |
"Step therapy protocol" means a protocol or program
that establishes a specific sequence in which prescription drugs that are for a
specified medical condition and that are consistent with medical or scientific
evidence for a particular patient are covered, under either a medical or
prescription drug benefit, by a health benefit plan, including both
self-administered and physician-administered drugs. |
| (G) |
"Urgent care services" has the same meaning as in
section
3923.041 of the
Revised Code. |
| (H) |
"Utilization review organization" has the same meaning
as in section
1751.77
of the Revised Code. |
Added by
132nd General Assembly File No. TBD, SB 265, §1,
eff.
4/5/2019.
| (A) |
If a health plan issuer or a utilization review
organization implements a step therapy protocol, that protocol shall be
implemented via clinical review criteria that are based on clinical practice
guidelines or medical or scientific evidence. |
| (B) |
When establishing a step therapy protocol, a health
plan issuer and a utilization review organization shall also take into account
the needs of atypical patient populations and diagnoses when establishing
clinical review criteria. |
| (C) |
This section shall not be construed as requiring
either a health plan issuer or the state to set up a new entity to develop
clinical review criteria for step therapy protocols. |
Added by
132nd General Assembly File No. TBD, SB 265, §1,
eff.
4/5/2019.
| (A) |
| (1) |
| (a) |
When coverage of a prescription drug for the treatment
of any medical condition is restricted for use by a health plan issuer or
utilization review organization through the use of a step therapy protocol, the
health plan issuer or utilization review organization shall provide the
prescribing health care provider access to a clear, easily accessible, and
convenient process to request a step therapy exemption on behalf of a covered
individual. A health plan issuer or utilization review organization may use its
existing medical exceptions process to satisfy this
requirement. |
| (b) |
A step therapy exemption request shall include
supporting documentation and rationale. |
|
| (2) |
| (a) |
A health plan issuer shall make available, to all
health care providers, a list of all drugs covered by the issuer that are
subject to a step therapy protocol. If the health plan issuer offers more than
one health benefit plan, and the covered drugs subject to a step therapy
protocol vary from one plan to another, then the health plan issuer shall issue
a separate list for each plan. |
| (b) |
Along with the information required under division
(A)(2)(a) of this section, a health plan issuer shall indicate what information
or documentation must be provided to the issuer or organization for a step
therapy exemption request to be considered complete. Such information shall be
provided for each drug, if the requirements vary according to the drug, plan,
or protocol in question. |
|
| (3) |
| (a) |
The list required under division (A)(2)(a) of this
section, along with the required information or documentation described in
division (A)(2)(b) of this section, shall be made available on the issuer's web
site or provider portal. |
| (b) |
A utilization review organization shall, for each
health benefit plan it oversees that implements a step therapy protocol,
similarly make the list and information required under divisions (A)(2)(a) and
(b) of this section available on its web site or provider
portal. |
|
| (4) |
From the time a step therapy exemption request is
received by a health plan issuer or utilization review organization, the issuer
or organization shall either grant or deny the request within the following
time frames:
| (a) |
Forty-eight hours for a request related to urgent care
services; |
| (b) |
Ten calendar days for all other
requests. |
|
| (5) |
| (a) |
A provider may, on behalf of the covered individual,
appeal any exemption request that is denied. |
| (b) |
From the time an appeal is received by a health plan
issuer or utilization review organization, the issuer or organization shall
either grant or deny the appeal within the following time frames:
| (i) |
Forty-eight hours for appeals related to urgent care
services; |
| (ii) |
Ten calendar days for all other
appeals. |
|
| (c) |
The appeal shall be between the health care provider
requesting the service in question and a clinical peer, as defined in section
3923.041 of the
Revised Code. |
| (d) |
| (i) |
The appeal shall be considered an internal appeal for
purposes of section
3922.03
of the Revised Code. |
| (ii) |
A health plan issuer shall not impose a step therapy
exemption appeal as an additional level of appeal beyond what is required under
section
3922.03
of the Revised Code, unless otherwise permitted by law. |
|
| (e) |
| (i) |
If the appeal does not resolve the disagreement, the
covered individual, or the covered individual's authorized representative, may
request an external review under Chapter 3922. of the Revised Code to the
extent Chapter 3922. of the Revised Code is applicable. |
| (ii) |
As used in division (A)(5)(e) of this section,
"authorized representative" has the same meaning as in section
3922.01 of the
Revised Code. |
|
|
| (6) |
If a health plan issuer or utilization review
organization does not either grant or deny an exemption request or an appeal
within the time frames prescribed in division (A)(4) or (5) of this section,
then such an exemption request or appeal shall be deemed to be
granted. |
|
| (B) |
Pursuant to a step therapy exemption request initiated
under division (A)(1) of this section or an appeal made under division (A)(5)
of this section, a health plan issuer or utilization review organization shall
grant a step therapy exemption if any of the following are met:
| (1) |
The required prescription drug is contraindicated for
that specific patient, pursuant to the drug's United States food and drug
administration prescribing information. |
| (2) |
The patient has tried the required prescription drug
while under their current, or a previous, health benefit plan, or another
United States food and drug administration approved AB-rated prescription drug,
and such prescription drug was discontinued due to lack of efficacy or
effectiveness, diminished effect, or an adverse event. |
| (3) |
The patient is stable on a prescription drug selected
by the patient's health care provider for the medical condition under
consideration, regardless of whether or not the drug was prescribed when the
patient was covered under the current or a previous health benefit plan, or has
already gone through a step therapy protocol. However, a health benefit plan
may require a stable patient to try a pharmaceutical alternative, per the
federal food and drug administration's orange book, purple book, or their
successors, prior to providing coverage for the prescribed
drug. |
|
| (C) |
Upon the granting of a step therapy exemption, the
health plan issuer or utilization review organization shall authorize coverage
for the prescription drug prescribed by the patient's treating health care
provider. |
| (D) |
This section shall not be construed to prevent either
of the following:
| (1) |
A health plan issuer or utilization review
organization from requiring a patient to try any new or existing pharmaceutical
alternative, per the federal food and drug administration's orange book, purple
book, or their successors, prior to providing or renewing coverage for the
prescribed drug; |
| (2) |
A health care provider from prescribing a prescription
drug, consistent with medical or scientific evidence. |
|
| (E) |
Committing a series of violations of this section
that, taken together, constitute a practice or pattern shall be considered an
unfair and deceptive practice under sections
3901.19
to
3901.26
of the Revised Code. |
Added by
132nd General Assembly File No. TBD, SB 265, §1,
eff.
4/5/2019.
The superintendent of insurance may adopt rules as necessary
to enforce sections
3901.83 to 3901.833 of
the Revised Code.
Added by
132nd General Assembly File No. TBD, SB 265, §1,
eff.
4/5/2019.
Repealed by
129th General AssemblyFile No.48, HB 218,
§2, eff.
12/26/2011.
Effective Date: 05-01-2000
.
| (A) |
When the
laws of any other state, district, territory, or nation impose any taxes,
fines, penalties, license fees, deposits of money, securities, or other
obligations or prohibitions on insurance companies of this state doing business
in that state, district, territory, or nation, or upon their agents therein,
the same obligations and prohibitions shall be imposed upon insurance companies
of the other state, district, or nation doing business in this state and upon
their agents. When the laws of any other state, district, territory, or
nation impose a requirement for countersignature and payment of a fee or
commission upon agents of this state for placing any coverage in that state,
district, territory, or nation, then the same requirements of countersignature
and fee or commission shall be imposed upon agents of that state, district,
territory, or nation for placing any coverage in this state.
|
| (B) |
Beginning on July 1, 1993, twenty per
cent of the amount that is collected under division (A) of this section from
foreign insurance companies that sell fire insurance to residents of this state
shall be paid into the state fire marshal's fund created under section
3737.71 of the Revised Code. The
director of commerce, with the approval of the director of budget and
management, may increase the percentage described in this division so that it
will yield an amount that the director of commerce determines necessary to
assist in the maintenance and administration of the office of the fire marshal
and in defraying the costs of operating the Ohio fire academy established by
section 3737.33 of the Revised Code.
|
Effective Date:
09-01-2002 .
| (A) |
No qualified
health plan shall provide coverage for a nontherapeutic abortion. |
| (B) |
As
used in this section:
| (1) |
"Nontherapeutic abortion" has the same meaning as in section
9.04 of the Revised Code. |
| (2) |
"Qualified health plan" means any qualified health plan as defined in section
1301 of the "Patient Protection and Affordable Care Act,"
42 U.S.C. 18021, offered in this state through an
exchange created under that act. |
|
Amended by
133rd General Assembly File No. TBD, HB 339, §1,
eff. 1/1/2021.
Added by
129th General AssemblyFile No.57, HB 79,
§1, eff.
3/22/2012.
The superintendent of insurance shall conduct an actuarial
study on the costs of all health care mandates under state law that apply to
individual and group health insurance plans that are not subject to the
"Employee Retirement Income Security Act of 1974,"
29 U.S.C. 1001, et seq. This study shall be delivered
electronically to the governor, the senate president, and the speaker of the
house not later than two years after the effective date of this
section.
Added by
131st General Assembly File No. TBD, HB 463, §1,
eff.
4/6/2017.
The superintendent of insurance, in consultation with the
director of mental health and addiction services, shall develop consumer and
payer education on mental health and addiction services insurance parity and
establish and promote a consumer hotline to collect information and help
consumers understand and access their insurance benefits.
The department of insurance and the department of mental
health and addiction services shall jointly report annually on the department's
efforts, which shall include information on consumer and payer outreach
activities and identification of trends and barriers to access and coverage in
this state. The departments shall submit the report to the general assembly,
the joint medicaid oversight committee, and the governor, not later than the
thirtieth day of January of each year.
Added by
132nd General Assembly File No. TBD, HB 49, §101.01, eff.
9/29/2017.
When the superintendent of insurance adopts or amends a
rule, including a rule related to the superintendent's duties and powers under
Chapters 1751. and 1753. and Title XXXIX of the Revised Code or a rule related
to an "insurance rating agency" as defined by section 1.65 of the Revised Code,
the superintendent shall give consideration to the inclusion in the rule of the
definition of "insurance rating agency" found in section 1.65 of the Revised
Code.
Added by
132nd General Assembly File No. TBD, SB 273, §1,
eff.
3/20/2019.
A direct primary care agreement that meets all of the
following shall not be considered insurance and nothing in Title XXXIX or
Chapter 1739., 1751., or 1753. of the Revised Code shall apply to such an
agreement:
| (B) |
It is between a patient, or that patient's legal
representative, and a health care provider and is related to services to be
provided in exchange for the payment of a fee to be paid on a periodic
basis. |
| (C) |
It allows either party to terminate the agreement as
specified in the agreement. |
| (D) |
It requires termination to be accomplished through
written notification. |
| (E) |
It permits termination to take effect immediately upon
the other party's receipt of the notification or not more than sixty days after
the other party's receipt of the notification. |
| (F) |
It does not impose a termination penalty or require
payment of a termination fee. |
| (G) |
It describes the health care services to be provided
under the agreement and the basis on which a periodic fee is to be paid in
exchange for those services. |
| (H) |
It specifies the periodic fee required and any
additional fees that may be charged. |
| (I) |
It authorizes the periodic fee and any additional fees
to be paid by a third party. |
| (J) |
It prohibits the health services provider from
charging or receiving any fee other than the fees prescribed in the agreement
for those services prescribed in the agreement. |
| (K) |
It conspicuously and prominently states that the
agreement is not health insurance, is not subject to the insurance laws of this
state, and does not meet any individual health insurance mandate that may be
required under federal law. |
Added by
133rd General Assembly File No. TBD, HB 166, §101.01, eff.
10/17/2019.
| (A) |
Whoever
violates section
3901.09 of the Revised Code shall
be fined not less than twenty-five nor more than five hundred dollars.
|
| (B) |
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. |
| (C) |
Whoever violates section
3901.54 of the Revised Code is
guilty of a felony of the fifth degree. |
| (D) |
Whoever violates division (J)(2) of section
3901.07 of the Revised Code is
guilty of a misdemeanor of the first degree. |
Effective Date:
07-01-1996 .