(a) Any program or arrangement covering only accident, | 29 |
credit,
dental, disability income, long-term care, hospital | 30 |
indemnity,
medicare supplement, medicare, tricare, specified | 31 |
disease, or
vision care; coverage under a | 32 |
one-time-limited-duration policy of
not longer than six months; | 33 |
coverage issued as a supplement to
liability insurance; insurance | 34 |
arising out of workers'
compensation or similar law; automobile | 35 |
medical payment insurance;
or insurance under which benefits are | 36 |
payable with or without
regard to fault and which is statutorily | 37 |
required to be contained
in any liability insurance policy or | 38 |
equivalent self-insurance. | 39 |
(1) The standardized identification card or the electronic | 52 |
technology shall be in a format and
contain information fields | 53 |
approved by the national council for
prescription drug programs or | 54 |
a successor organization, as specified in the council's or | 55 |
successor organization's pharmacy
identification card | 56 |
implementation guide in effect on the first
day of October most | 57 |
immediately preceding the issuance or required use of the | 58 |
standardized identification card or the electronic technology. | 59 |
(C) If the standardized identification card or the electronic | 77 |
technology issued or required to be used as provided in division | 78 |
(A)(1) of this section is also used for submission and routing of | 79 |
nonpharmacy
claims, the designation "Rx" is required to be | 80 |
included as part of the labels identified in divisions (B)(2)(d) | 81 |
and
(e) of this section if the issuer's international | 82 |
identification number or the processor's control number is | 83 |
different for medical and pharmacy claims. | 84 |
(E)(1) Except as provided in division (E)(2) of this section, | 91 |
if there is a change in the information contained in the | 92 |
standardized identification card or the electronic technology | 93 |
issued to an individual, the multiple employer welfare arrangement | 94 |
or person under contract with it to issue a standardized | 95 |
identification card or an electronic technology shall issue a new | 96 |
card or electronic technology to the individual. | 97 |
(1) The standardized identification card or the electronic | 138 |
technology shall be in a format and
contain information fields | 139 |
approved by the national council for
prescription drug programs or | 140 |
a successor organization, as specified in the council's or | 141 |
successor organization's pharmacy
identification card | 142 |
implementation guide in effect on the first
day of October most | 143 |
immediately preceding the issuance or required use of the | 144 |
standardized identification
card or the electronic technology. | 145 |
(C) If the standardized identification card or the electronic | 163 |
technology issued or required to be used as provided in division | 164 |
(A)(1) of this section is also used for submission and routing of | 165 |
nonpharmacy
claims, the designation "Rx" is required to be | 166 |
included as part of the labels identified in divisions (B)(2)(d) | 167 |
and (e) of this section if the issuer's international | 168 |
identification number or the processor's control number is | 169 |
different for medical and pharmacy claims. | 170 |
(E)(1) Except as provided in division (E)(2) of this section, | 177 |
if there is a change in the information contained in the | 178 |
standardized identification card or the electronic technology | 179 |
issued to a subscriber, the health insuring corporation or person | 180 |
under contract with the corporation to issue a standardized | 181 |
identification card or an electronic technology shall issue a new | 182 |
card or electronic technology to the subscriber. | 183 |
Sec. 3917.01. (A) Group life insurance is that form of
life | 193 |
insurance covering not less than tentwo employees with or
without | 194 |
medical examination, written under a policy issued to the | 195 |
employer, or to a trustee of a trust created by such employer,
the | 196 |
premium on which is to be paid by the employer, by the
employer | 197 |
and employees jointly, or by such trustee out of funds
contributed | 198 |
by the employer or by the employer and employees
jointly, and | 199 |
insuring only all of the employer's employees
or all of any | 200 |
classes thereof, determined by sex, age, or conditions pertaining | 201 |
to the employment, for amounts of insurance based upon some plan | 202 |
which will preclude individual selection, for the benefit of | 203 |
persons other than the employer; but when the premium is to be | 204 |
paid by the employer and employee jointly and the benefits of the | 205 |
policy are offered to all eligible employees, not less than | 206 |
seventy-five per cent of such employees may be so insured. Such | 207 |
group policy may provide that "employees" includes retired | 208 |
employees of the employer and the officers, managers, employees, | 209 |
and retired employees of subsidiary or affiliated corporations
and | 210 |
the individual proprietors, partners, employees, and retired | 211 |
employees of affiliated individuals and firms, when the business | 212 |
of such subsidiary or affiliated corporations, firms, or | 213 |
individuals is controlled by the common employer through stock | 214 |
ownership, contract, or otherwise. This section does not define
as | 215 |
a group the lives covered by a policy issued on more than one
life | 216 |
which provides for payments upon the death of any one or
more or | 217 |
upon the death of each of the lives so insured, and upon
which the | 218 |
premium rates charged are computed on the same basis as
used by | 219 |
the issuing company on single life policies and upon its
regular | 220 |
forms of insurance. | 221 |
(1) Life insurance covering the members of one or more | 225 |
companies, batteries, troops, battalions, divisions, or other | 226 |
units of the national guard or naval militia of any state,
written | 227 |
under a policy issued to the commanding general of the
national | 228 |
guard or commanding officer of the naval militia, who is
the | 229 |
employer for the purposes of such sections, the premium on
which | 230 |
is to be paid by the members of such units for the benefit
of | 231 |
persons other than the employer; provided that when the
benefits | 232 |
of the policy are offered to all eligible members of a
unit of the | 233 |
national guard or naval militia, not less than
seventy-five per | 234 |
cent of the members of such a unit may be
insured; | 235 |
(2) Life insurance covering the members of one or more
troops | 236 |
or other units of the state troopers or state police of
any state, | 237 |
written under a policy issued to the commanding
officer of the | 238 |
state troopers or state police who is the employer
for the | 239 |
purposes of such sections, the premium on which is to be
paid by | 240 |
the members of such units for the benefit of persons
other than | 241 |
the employer; provided that when the benefits of the
policy are | 242 |
offered to all eligible members of a unit of the state
troopers or | 243 |
state police, not less than seventy-five per cent of
the members | 244 |
of such a unit may be insured; | 245 |
(3) Life insurance covering the members of any labor
union, | 246 |
written under a policy issued to such union which is the
employer | 247 |
for the purposes of such sections, the premium on which
is to be | 248 |
paid by the union or by the union and its members
jointly, and | 249 |
insuring only all of its members, who are actively
engaged in the | 250 |
same occupation, for amounts of insurance based
upon some plan | 251 |
which will preclude individual selection, for the
benefit of | 252 |
persons other than the union or its officials;
provided that in | 253 |
case the insurance policy is cancellable at the
end of any policy | 254 |
year at the option of the insurance company and
that the basis of | 255 |
premium rates may be changed by the insurance
company at the | 256 |
beginning of any policy year, all members of a
labor union may be | 257 |
insured; and provided that when the premium is
to be paid by the | 258 |
union and its members jointly and the benefits
are offered to all | 259 |
eligible members, not less than seventy-five
per cent of such | 260 |
members may be insured; and provided that when
members apply and | 261 |
pay for additional amounts of insurance, a
smaller percentage of | 262 |
members may be insured for such additional
amounts if they pass | 263 |
satisfactory medical examinations or submit
satisfactory evidence | 264 |
of insurability; | 265 |
(a) The debtors eligible for insurance under the policy
shall | 269 |
be all of the debtors of the creditor, excepting that no debtor is | 270 |
eligible
unless
the indebtedness constitutes an obligation to | 271 |
repay that
is binding upon the debtor during the
debtor's lifetime | 272 |
at and from the date the insurance becomes effective
upon the | 273 |
debtor's life. The policy may provide that
"debtors" includes the | 274 |
debtors of one or more subsidiary corporations and the
debtors of | 275 |
one or more affiliated corporations, proprietors, or partnerships | 276 |
if the business of the
policyholder and of such affiliated | 277 |
corporations, proprietors, or
partnerships is under common control | 278 |
through stock ownership,
contract, or otherwise. | 279 |
(b) The premium for the policy shall be paid by the | 280 |
policyholder, either from the creditor's funds, or from charges | 281 |
collected from the insured debtors, or from both. A policy on | 282 |
which part or all of the premium is to be derived from the | 283 |
collection from the insured debtors of identifiable charges not | 284 |
required of uninsured debtors shall not include debtors under | 285 |
obligations outstanding at its date of issue without evidence of | 286 |
individual insurability unless at least seventy-five per cent of | 287 |
the then eligible debtors elect to pay the required charges. A | 288 |
policy on which no part of the premium is to be derived from the | 289 |
collection of such identifiable charges must insure all eligible | 290 |
debtors, or all except any as to whom evidence of individual | 291 |
insurability is not satisfactory to the insurer. | 292 |
(c) The policy may be issued only if the group of eligible | 293 |
debtors is then receiving new entrants at the rate of at least
one | 294 |
hundred persons yearly, or may reasonably be expected to
receive | 295 |
at least one hundred new entrants during the first policy
year, | 296 |
and continues to receive not less than one hundred new
entrants to | 297 |
the group yearly, and only if the policy reserves to
the insurer | 298 |
the right to require evidence of individual
insurability if less | 299 |
than seventy-five per cent of the new
entrants become insured. The | 300 |
policy may exclude from the classes
eligible for insurance classes | 301 |
of debtors determined by age. | 302 |
(5) Life insurance covering the members of any duly
organized | 311 |
corporation or association of veterans or veteran
society or | 312 |
association of the World War veterans, written under a
policy | 313 |
issued to such corporation, association, or society which
is the | 314 |
employer for the purpose of such sections, the premium on
which is | 315 |
to be paid by the corporation, association, society, and
its | 316 |
members jointly, and insuring all of its members who are
actively | 317 |
engaged in any occupation for amounts of insurance based
upon some | 318 |
plan which will preclude individual selection for the
benefit of | 319 |
persons other than the corporation, association, or
society or its | 320 |
officials; provided that when the premium is to be
paid by the | 321 |
corporation, association, or society and its members
jointly and | 322 |
the benefits are offered to all eligible members, not
less than | 323 |
seventy-five per cent of such members may be insured;
and provided | 324 |
that when members apply and pay for additional
amounts of | 325 |
insurance, a smaller percentage of members may be
insured for such | 326 |
additional amounts if they pass satisfactory
medical examinations | 327 |
or submit satisfactory evidence of
insurability; | 328 |
(6) Life insurance covering the members of any
organization | 329 |
of agriculturists or horticulturists organized under
the | 330 |
co-operative laws of this state, written under a policy
issued to | 331 |
such co-operative association which is the employer for
the | 332 |
purpose of such sections, the premium on which is to be paid
by | 333 |
the association or by the association and its members jointly,
and | 334 |
insuring all of its members who are actively engaged in | 335 |
agricultural or horticultural pursuits, for an amount of
insurance | 336 |
based upon some plan which will preclude individual
selection, and | 337 |
for the benefit of persons other than the
association or its | 338 |
officials; provided that when the premium is
to be paid by the | 339 |
corporation, association, or society and its
members jointly and | 340 |
the benefits are offered to all eligible
members, not less than | 341 |
seventy-five per cent of such members may
be insured; provided | 342 |
that when members apply and pay for
additional amounts of | 343 |
insurance, a smaller percentage of members
may be insured for such | 344 |
additional amounts if they pass
satisfactory medical examinations | 345 |
or submit satisfactory evidence
of insurability; | 346 |
(7) Life insurance covering employees of a political | 347 |
subdivision or district of this state, or of an educational or | 348 |
other institution supported in whole or in part by public funds, | 349 |
or of any classes thereof, determined by conditions pertaining to | 350 |
employment, or of this state or any department or division | 351 |
thereof, written under a policy issued to such political | 352 |
subdivision, district, or institution, or the proper official or | 353 |
board of this state or of such state department or division | 354 |
thereof, which is the employer for the purpose of such sections, | 355 |
the premium on which is to be paid by such employees, unless | 356 |
otherwise provided by law, charter, or ordinance, for the benefit | 357 |
of persons other than the employer; provided that when the | 358 |
benefits of the policy are offered to all eligible employees of a | 359 |
political subdivision or district of the state or of an | 360 |
educational or other institution supported in whole, or in part
by | 361 |
public funds, or of this state or a state department or
division | 362 |
thereof, not less than seventy-five per cent of such
employees may | 363 |
be insured; and provided that when employees apply
and pay for | 364 |
additional amounts of insurance, a smaller percentage
of employees | 365 |
may be insured for such additional amounts if they
pass | 366 |
satisfactory medical examinations or submit satisfactory
evidence | 367 |
of insurability; and provided that upon acquisition by a
political | 368 |
subdivision of any privately owned property or
enterprise, the | 369 |
employees of which have been covered by a group
policy of life or | 370 |
other insurance as employees of such private
employer, such | 371 |
political subdivision and insurance company may
continue such | 372 |
contract in force upon similar conditions as the
last preceding | 373 |
private employer; | 374 |
(8) Life insurance covering the members, or the members
and | 375 |
the employees of members of any duly organized association,
other | 376 |
than an association subject to any other provision of this | 377 |
division, written under a policy issued to such association,
which | 378 |
association is the employer for the purpose of such
sections, the | 379 |
premium on which is to be paid by the insured
members or their | 380 |
employees, insuring members and their employees
for amounts of | 381 |
insurance based upon some plan which will preclude
individual | 382 |
selection except as provided in this section, for the
benefit of | 383 |
persons other than the association; provided the
association has | 384 |
been in existence for at least two years
immediately preceding the | 385 |
purchase of the insurance; provided
that there must be at least | 386 |
fifty insured members in any group;
and provided that the | 387 |
association has been organized and is
maintained in good faith for | 388 |
purposes other than that of
obtaining insurance; | 389 |
(9) Life insurance issued to trustees of a trust fund | 390 |
established jointly by one or more employers in the same
industry, | 391 |
on the one hand, and one or more labor unions
representing as | 392 |
bargaining agents employees of such employers, on
the other hand, | 393 |
or by two or more employers in the same industry,
or by two or | 394 |
more labor unions, which trustees shall be deemed
the policyholder | 395 |
to insure employees of the employers or members
of unions for the | 396 |
benefit of persons other than the employers or
the unions or the | 397 |
trustees, subject to the following
requirements: | 398 |
(a) The persons eligible for such insurance shall be all
of | 399 |
the employees of the employers, or all of the members of the | 400 |
unions, or all of any class of such employees determined by sex, | 401 |
age, or conditions pertaining to their employment, or to | 402 |
membership in the unions, or to any or all of them. The policy
may | 403 |
provide that "employees" includes the retired employees of
the | 404 |
employer and the officers, managers, employees, and retired | 405 |
employees of subsidiary or affiliated corporations and the | 406 |
individual proprietors, partners, employees, and retired
employees | 407 |
of affiliated individuals and firms, when the business
of such | 408 |
subsidiary or affiliated corporations, firms, or
individuals is | 409 |
controlled by the common employer through stock
ownership, | 410 |
contract, or otherwise. The policy may provide that
"employees" | 411 |
includes the individual proprietor or partners if the
employer is | 412 |
an individual proprietor or a partnership. The policy
may provide | 413 |
that "employees" includes the trustees or their
employees, or | 414 |
both, if their duties are principally connected
with such | 415 |
trusteeship. | 416 |
(b) The premium for the policy shall be paid by the
trustees, | 417 |
either wholly from funds contributed by the employers
of the | 418 |
insured persons, or partly from such funds and partly from
funds | 419 |
contributed by the insured employees. If part of the
premium is to | 420 |
be derived from funds contributed by the insured
employees, then | 421 |
such policy may be placed in force only if it
covers at least | 422 |
seventy-five per cent of the then eligible
employees. A policy on | 423 |
which no part of the premium is derived
from funds contributed by | 424 |
the insured employees must insure all
eligible employees. | 425 |
(10) Life insurance covering the members of a credit
union, | 432 |
which shall be deemed to be the employer for the purposes
of this | 433 |
section, the premium on which is to be paid by the credit
union or | 434 |
by the credit union and its members jointly, and
insuring all of | 435 |
its eligible members for amounts of insurance not
in excess of the | 436 |
share balance as to each member, and for the
benefit of persons | 437 |
other than the credit union or its officers;
provided that in the | 438 |
determination of the eligibility of members
there may be | 439 |
classifications and limitations based upon age;
provided also that | 440 |
when the premium is to be paid by the credit
union and its members | 441 |
jointly and the benefits are offered to all
eligible members, not | 442 |
less than seventy-five per cent of such
members may be so insured; | 443 |
provided also that in obtaining such
insurance, the officers of | 444 |
the credit union shall consider
proposals from any licensed | 445 |
insurer; provided also that members
may be required to provide | 446 |
evidence of insurability satisfactory
to the insurer. | 447 |
(11) Life insurance covering the members of any duly | 448 |
organized corporation or association of members of the Ohio | 449 |
national guard, the Ohio naval militia, and the Ohio military | 450 |
reserve, which shall have been in existence for at least two
years | 451 |
immediately preceding the purchase of such insurance,
written | 452 |
under a policy issued to such corporation or association,
which | 453 |
corporation or association is the employer for the purpose
of such | 454 |
sections, the premium on which is to be paid by the
insured | 455 |
members, insuring members for amounts of insurance based
upon some | 456 |
plan which will preclude individual selection, except
as provided | 457 |
in this section, for the benefit of persons other
than the | 458 |
corporation or association, provided that there must be
at least | 459 |
fifty insured members in any group, and provided further
that | 460 |
unless seventy-five per cent of all members or one thousand | 461 |
members, whichever is the lesser number, are insured, each member | 462 |
must pass a satisfactory medical examination in order to be | 463 |
insured; and provided that, when members apply and pay for | 464 |
additional amounts of insurance, they may be insured for such | 465 |
additional amounts if they pass satisfactory medical examinations | 466 |
or submit satisfactory evidence of insurability. | 467 |
(12) Life insurance that is written under a policy
issued to | 468 |
a trustee under a trust established by an insurer for
the purpose | 469 |
of providing continued group life insurance coverage
to those | 470 |
former employees,
former members, or former members and the | 471 |
employees of such members, and their
spouses and dependent | 472 |
children,
previously covered under policies of group life | 473 |
insurance issued
by the insurer to employers or trustees pursuant | 474 |
to
division (A) of this section, to associations pursuant to | 475 |
division
(B)(8) of this section, or to trustees pursuant to | 476 |
division
(B)(9) of this section, and
that is evidenced by the | 477 |
issuance of a certificate of insurance
to such former employees or | 478 |
members; provided that the amount of the continued
life
insurance | 479 |
coverage made available to a former employee or member and to
the | 480 |
employee's or member's spouse and dependents shall not exceed the | 481 |
amount
of the group life insurance coverage previously provided to | 482 |
the employee or member and the employee's or member's eligible | 483 |
dependents at
the time
of the
employee's separation from | 484 |
employment or the member's termination of
membership. | 485 |
(13) Life insurance covering the members of a workforce | 486 |
actively engaged in an occupation for, and performing services on | 487 |
behalf of, a duly organized corporation, limited liability | 488 |
company, partnership, proprietor, or similar organization, whose | 489 |
members are not employees of the organization, written under a | 490 |
policy issued to the organization, which organization is the | 491 |
members' employer for this purpose, the premium on which is to be | 492 |
paid by the organization or by the organization and the members | 493 |
jointly, insuring members for amounts of insurance based upon some | 494 |
plan which will preclude individual selection, for the benefit of | 495 |
persons other than the organization; provided, that when the | 496 |
premium is to be paid by the organization and its members jointly | 497 |
and the benefits are offered to all eligible members, not less | 498 |
than seventy-five per cent of the members may be so insured; | 499 |
provided also that members may be required to furnish evidence of | 500 |
insurability satisfactory to the insurer. Life insurance meeting | 501 |
this definition may also cover the organization's employees at the | 502 |
option of the organization. | 503 |
(C) Any policy issued pursuant to this section, except a | 504 |
policy issued to a creditor pursuant to division (B)(4) of this | 505 |
section, may be extended, in the form of group term life
insurance | 506 |
only, to insure the spouse and dependent children of an
insured | 507 |
employee or member, or any class or classes thereof,
subject to | 508 |
the following requirements: | 509 |
(a) Any individual or group policy of
sickness and accident | 542 |
insurance covering only accident, credit,
dental, disability | 543 |
income, long-term care, hospital indemnity,
medicare supplement, | 544 |
medicare, tricare, specified disease, or
vision care; coverage | 545 |
under a one-time-limited-duration policy of
not longer than six | 546 |
months; coverage issued as a supplement to
liability insurance; | 547 |
insurance arising out of workers'
compensation or similar law; | 548 |
automobile medical payment insurance;
or insurance under which | 549 |
benefits are payable with or without
regard to fault and which is | 550 |
statutorily required to be contained
in any liability insurance | 551 |
policy or equivalent self-insurance. | 552 |
(1) The standardized identification card or the electronic | 565 |
technology shall be in a format and
contain information fields | 566 |
approved by the national council for
prescription drug programs or | 567 |
a successor organization, as specified in the council's or | 568 |
successor organization's pharmacy
identification card | 569 |
implementation guide in effect on the first
day of October most | 570 |
immediately preceding the issuance or required use of the | 571 |
standardized identification card or the electronic technology. | 572 |
(C) If the standardized identification card or the electronic | 588 |
technology issued or required to be used as provided in division | 589 |
(A)(1) of this section is also used for submission and routing of | 590 |
nonpharmacy
claims, the designation "Rx" is required to be | 591 |
included as part of the labels identified in divisions (B)(2)(d) | 592 |
and
(e) of this section if the issuer's international | 593 |
identification number or the processor's control number is | 594 |
different for medical and pharmacy claims. | 595 |
(a) Any individual or group policy of insurance covering only | 634 |
accident, credit,
dental, disability income, long-term care, | 635 |
hospital indemnity,
medicare supplement, medicare, tricare, | 636 |
specified disease, or
vision care; coverage under a | 637 |
one-time-limited-duration policy of
not longer than six months; | 638 |
coverage issued as a supplement to
liability insurance; insurance | 639 |
arising out of workers'
compensation or similar law; automobile | 640 |
medical payment insurance;
or insurance under which benefits are | 641 |
payable with or without
regard to fault and which is statutorily | 642 |
required to be contained
in any liability insurance policy or | 643 |
equivalent self-insurance. | 644 |
(1) The standardized identification card or the electronic | 652 |
technology shall be in a format and
contain information fields | 653 |
approved by the national council for
prescription drug programs or | 654 |
a successor organization, as specified in the council's or | 655 |
successor organization's pharmacy
identification card | 656 |
implementation guide in effect on the first
day of October most | 657 |
immediately preceding the issuance or required use of the | 658 |
standardized identification card or the electronic technology. | 659 |
(C) If the standardized identification card or the electronic | 676 |
technology issued or required to be used as provided in division | 677 |
(A)(1) of this section is also used for submission and routing of | 678 |
nonpharmacy
claims, the designation "Rx" is required to be | 679 |
included as part of the labels identified in divisions (B)(2)(d) | 680 |
and
(e) of this section if the issuer's international | 681 |
identification number or the processor's control number is | 682 |
different for medical and pharmacy claims. | 683 |
(D)(1) Except as provided in division (D)(2) of this section, | 684 |
if there is a change in the information contained in the | 685 |
standardized identification card or the electronic technology | 686 |
issued to an insured, the public employee benefit plan or person | 687 |
under contract with the plan to issue a standardized | 688 |
identification card or electronic technology shall issue a new | 689 |
card or electronic technology to the insured. | 690 |