Sec. 9.90. (A) The governing board of any public
institution | 12 |
of higher education, including without limitation
state | 13 |
universities and colleges, community college districts,
university | 14 |
branch districts, technical college districts, and
municipal | 15 |
universities, or the board of education of any school
district, | 16 |
may, in addition to all other powers provided in the
Revised Code: | 17 |
(1) Contract for, purchase, or otherwise procure from an | 18 |
insurer or insurers licensed to do business by the state of Ohio | 19 |
for or on behalf of such of its employees as it may determine, | 20 |
life insurance, or sickness, accident, annuity, endowment,
health, | 21 |
medical, hospital, dental, or surgical coverage and
benefits, or | 22 |
any combination thereof, by means of insurance plans
or other | 23 |
types of coverage, family, group or otherwise, and may
pay from | 24 |
funds under its control and available for such purpose
all or any | 25 |
portion of the cost, premium, or charge
for such insurance, | 26 |
coverage, or benefits. However, the governing
board, in addition | 27 |
to or as an alternative to the authority otherwise
granted by | 28 |
division (A)(1) of this section, may elect to procure
coverage for | 29 |
health care services, for or on behalf of such of its employees
as | 30 |
it may determine, by means of policies,
contracts, certificates, | 31 |
or agreements issued by at least two
health insuring corporations | 32 |
holding a certificate of authority
under Chapter 1751. of the | 33 |
Revised Code and may
pay from funds
under the governing board's | 34 |
control and available for such purpose all or
any portion of the | 35 |
cost of such coverage. | 36 |
Any income of an employee deferred under divisions (A)(1)
and | 43 |
(2) of this section in a deferred compensation program
eligible | 44 |
for favorable tax treatment under the Internal Revenue
Code of | 45 |
1954, as amended, shall continue to be included as
regular | 46 |
compensation for the purpose of computing the
contributions to and | 47 |
benefits from the retirement system of such
employee. Any sum so | 48 |
deferred shall not be included in the
computation of any federal | 49 |
and state income taxes withheld on
behalf of any such employee. | 50 |
(B) All or any portion of the cost, premium, or charge | 51 |
therefor may be paid in such other manner or combination of | 52 |
manners as the governing board or the school board may determine, | 53 |
including direct payment by the employee in cases under division | 54 |
(A)(1) of this section, and, if authorized in writing by the | 55 |
employee in cases under division (A)(1) or (2) of this section,
by | 56 |
such governing board or school board with moneys made
available by | 57 |
deduction from or reduction in salary or wages or by
the foregoing | 58 |
of a salary or wage increase. Division (B)(7) ofNothing in | 59 |
section 3917.01 and the last paragraph ofor section 3917.06 of | 60 |
the
Revised Code shall not prohibit the issuance or purchase of | 61 |
group
life insurance authorized by this section by reason of | 62 |
payment of
premiums therefor by the governing board or the school | 63 |
board from
its funds, and such group life insurance may be so | 64 |
issued and
purchased if otherwise consistent with the provisions | 65 |
of sections
3917.01 to 3917.07 of the Revised Code. | 66 |
Sec. 1751.12. (A)(1) No
contractual periodic prepayment and | 67 |
no premium rate for nongroup and
conversion policies for health | 68 |
care services, or any amendment
to them, may be used by any health | 69 |
insuring corporation at any
time until the contractual periodic | 70 |
prepayment and premium rate, or
amendment, have been filed with | 71 |
the superintendent of insurance,
and shall not be effective until | 72 |
the expiration of sixty days
after their filing unless the | 73 |
superintendent sooner gives
approval. The filing shall be | 74 |
accompanied by an actuarial
certification in the form prescribed | 75 |
by the
superintendent. The superintendent shall disapprove the | 76 |
filing, if
the superintendent determines within the sixty-day | 77 |
period that
the contractual periodic prepayment or premium rate, | 78 |
or amendment, is
not in accordance with sound actuarial principles | 79 |
or is not
reasonably related to the applicable coverage and | 80 |
characteristics of the applicable class of enrollees. The | 81 |
superintendent shall notify the health insuring corporation of
the | 82 |
disapproval, and it shall thereafter be unlawful for the
health | 83 |
insuring corporation to use the contractual periodic
prepayment or | 84 |
premium rate, or amendment. | 85 |
(2) No contractual periodic prepayment for group
policies for | 86 |
health care services shall be used until the
contractual periodic | 87 |
prepayment has been filed with
the superintendent. The filing | 88 |
shall be accompanied by an actuarial
certification in the form | 89 |
prescribed by the
superintendent.
The superintendent may reject a | 90 |
filing made
under division (A)(2) of this section at any time, | 91 |
with
at least thirty days' written notice to a health insuring | 92 |
corporation, if the contractual periodic prepayment is not
in | 93 |
accordance with sound
actuarial principles or is not reasonably | 94 |
related to the
applicable coverage and characteristics of the | 95 |
applicable class
of enrollees. | 96 |
(3) At any time, the superintendent, upon at least thirty | 97 |
days' written notice to a health insuring corporation, may | 98 |
withdraw the approval given under division (A)(1) of this section, | 99 |
deemed or actual, of any contractual
periodic prepayment or | 100 |
premium rate, or amendment, based on
information that either of | 101 |
the following applies: | 102 |
(4) Any disapproval under division (A)(1) of this section, | 108 |
any rejection of a filing made under division (A)(2) of
this | 109 |
section, or any
withdrawal of approval under division (A)(3) of | 110 |
this section, shall
be effected by a written notice, which shall | 111 |
state the specific
basis for the disapproval, rejection, or | 112 |
withdrawal and shall be issued
in accordance with Chapter 119. of | 113 |
the
Revised Code. | 114 |
(B) Notwithstanding division (A) of this section, a
health | 115 |
insuring corporation may use a contractual periodic
prepayment or | 116 |
premium rate for policies used for the coverage of
beneficiaries | 117 |
enrolled in Title
XVIII of the "Social Security Act," 49
Stat. 620 | 118 |
(1935), 42
U.S.C.A.
301, as amended, pursuant to a medicare risk | 119 |
contract or
medicare cost contract, or for policies used for the | 120 |
coverage of
beneficiaries enrolled in the federal employees health | 121 |
benefits
program pursuant to 5
U.S.C.A.
8905, or for policies used | 122 |
for the coverage of beneficiaries
enrolled in Title
XIX of the | 123 |
"Social Security Act," 49
Stat. 620 (1935), 42
U.S.C.A.
301, as | 124 |
amended, known as the
medical assistance program or medicaid, | 125 |
provided
by the department of job and family services
under | 126 |
Chapter 5111.
of the Revised Code, or for policies used for the | 127 |
coverage
of beneficiaries under any other federal health care | 128 |
program regulated by a
federal regulatory body,
or for policies | 129 |
used for the coverage of beneficiaries
under any contract covering | 130 |
officers or employees of the state
that has been entered into by | 131 |
the department of
administrative services,
if both of the | 132 |
following
apply: | 133 |
(b) Impose copayment charges that annually do not exceed | 161 |
twenty per cent of the total annual cost to the health insuring | 162 |
corporation of providing all covered basic health care services, | 163 |
including physician office visits, urgent care services, and | 164 |
emergency health services, when aggregated as to all persons | 165 |
covered under the filed product in question. In addition, annual | 166 |
copayment charges as to each enrollee shall not exceed twenty per | 167 |
cent of the total annual cost to the health insuring corporation | 168 |
of providing all covered basic health care services, including | 169 |
physician office visits, urgent care services, and emergency | 170 |
health services, as to such enrollee. The total annual cost of | 171 |
providing
a health care service is the cost to the health insuring | 172 |
corporation of providing the health care service to its
enrollees | 173 |
as reduced by any applicable provider discount. | 174 |
(A) A life insurance policy issued to thean
employer, or to | 215 |
a trusteethe trustees of a trust createdfund established by such | 216 |
an employer,
the premium on which is to be paid by the employer, | 217 |
by the
employer and employees jointly, or by such trustee out of | 218 |
funds
contributed by the employer or by the employer and employees | 219 |
jointly, and insuring only all of the employer's employees
or all | 220 |
of any
classes thereof, determined by sex, age, or conditions | 221 |
pertaining
to the employment, for amounts of insurance based upon | 222 |
some plan
which will preclude individual selection,which employer | 223 |
or trustees shall be deemed the policyholder, to insure employees | 224 |
of the employer for the benefit of
persons other than the | 225 |
employer; but when the premium is to be
paid by the employer and | 226 |
employee jointly and the benefits of the
policy are offered to all | 227 |
eligible employees, not less than
seventy-five per cent of such | 228 |
employees may be so insured. Such
group, subject to all of the | 229 |
following requirements: | 230 |
(1) All of the employees of the employer, or all of any class | 231 |
or classes of employees, are eligible for life insurance. The | 232 |
policy may provide that "employees" includes the employees of one | 233 |
or more subsidiary corporations and the employees, individual | 234 |
proprietors, and partners of one or more affiliated corporations, | 235 |
proprietorships, or partnerships if the business of the employer | 236 |
and the affiliated corporations, proprietorships, or partnerships | 237 |
is under common control. The policy may provide that "employees" | 238 |
includes retired
employees of the employer and the officers, | 239 |
managers, former employees,
and retired employees of subsidiary or | 240 |
affiliated corporations
and the individual proprietors, partners, | 241 |
employees, and retired
employees of affiliated individuals and | 242 |
firms, when the business
of such subsidiary or affiliated | 243 |
corporations, firms, or
individuals is controlled by the common | 244 |
employer through stock
ownership, contract, or otherwise. This | 245 |
section does not define
as a group the lives covered by a policy | 246 |
issued on more than one
life which provides for payments upon the | 247 |
death of any one or
more or upon the death of each of the lives so | 248 |
insured, and upon
which the premium rates charged are computed on | 249 |
the same basis as
used by the issuing company on single life | 250 |
policies and upon its
regular forms of insurance. | 251 |
(1) Life insurance covering the members of one or more | 255 |
companies, batteries, troops, battalions, divisions, or other | 256 |
units of the national guard or naval militia of any state,
written | 257 |
under a policy issued to the commanding general of the
national | 258 |
guard or commanding officer of the naval militia, who is
the | 259 |
employer for the purposes of such sections, the premium on
which | 260 |
is to be paid by the members of such units for the benefit
of | 261 |
persons other than the employer; provided that when the
benefits | 262 |
of the policy are offered to all eligible members of a
unit of the | 263 |
national guard or naval militia, not less than
seventy-five per | 264 |
cent of the members of such a unit may be
insured; | 265 |
(2) Life insurance covering the members of one or more
troops | 266 |
or other units of the state troopers or state police of
any state, | 267 |
written under a policy issued to the commanding
officer of the | 268 |
state troopers or state police who is the employer
for the | 269 |
purposes of such sections, the premium on which is to be
paid by | 270 |
the members of such units for the benefit of persons
other than | 271 |
the employer; provided that when the benefits of the
policy are | 272 |
offered to all eligible members of a unit of the state
troopers or | 273 |
state police, not less than seventy-five per cent of
the members | 274 |
of such a unit may be insured; | 275 |
(3) Life insurance covering the members of any labor
union, | 276 |
written under a policy issued to such union which is the
employer | 277 |
for the purposes of such sections, the premium on which
is to be | 278 |
paid by the union or by the union and its members
jointly, and | 279 |
insuring only all of its members, who are actively
engaged in the | 280 |
same occupation, for amounts of insurance based
upon some plan | 281 |
which will preclude individual selection, for the
benefit of | 282 |
persons other than the union or its officials;
provided that in | 283 |
case the insurance policy is cancellable at the
end of any policy | 284 |
year at the option of the insurance company and
that the basis of | 285 |
premium rates may be changed by the insurance
company at the | 286 |
beginning of any policy year, all members of a
labor union may be | 287 |
insured; and provided that when the premium is
to be paid by the | 288 |
union and its members jointly and the benefits
are offered to all | 289 |
eligible members, not less than seventy-five
per cent of such | 290 |
members may be insured; and provided that when
members apply and | 291 |
pay for additional amounts of insurance, a
smaller percentage of | 292 |
members may be insured for such additional
amounts if they pass | 293 |
satisfactory medical examinations or submit
satisfactory evidence | 294 |
of insurability; | 295 |
(B) A life insurance policy issued to a
creditor, whoor its | 312 |
parent holding company or to a trustee or trustees or agent | 313 |
designated by two or more creditors, which creditor, holding | 314 |
company, affiliate, trustee, trustees, or agent shall be deemed | 315 |
the policyholder, to insure debtors
of the creditor or creditors, | 316 |
subject to the following requirements: | 317 |
(a)(1) The debtors eligible for insurance under the policy | 318 |
shall be all of the debtors of the creditor, excepting that no | 319 |
debtor is
eligible
unless
the indebtedness constitutes an | 320 |
obligation to repay that
is binding upon the debtor during the | 321 |
debtor's lifetime at and from the date the insurance becomes | 322 |
effective
upon the debtor's lifeor creditors, or all of any class | 323 |
or classes of the debtors. The policy may provide that
"debtors" | 324 |
includes theall of the following: | 325 |
(b)(2) The premium for the policy shall be paid by the | 336 |
policyholder, either from the creditor's funds, or from charges | 337 |
collected from the insured debtors, or from both. A policy on | 338 |
which part or all of the premium is to be derived from the | 339 |
collection from the insured debtors of identifiable charges not | 340 |
required of uninsured debtors shall not include debtors under | 341 |
obligations outstanding at its date of issue without evidence of | 342 |
individual insurability unless at least seventy-five per cent of | 343 |
the then eligible debtors elect to pay the required charges. A | 344 |
Except as provided in division (B)(3) of this section, a
policy on | 345 |
which no part of the premium is to be derived from the
collection | 346 |
of such identifiable charges mustfunds contributed by insured | 347 |
debtors specifically for the debtors' insurance shall insure all | 348 |
eligible
debtors, or all except any. | 349 |
(c) The policy may be issued only if the group of eligible | 352 |
debtors is then receiving new entrants at the rate of at least
one | 353 |
hundred persons yearly, or may reasonably be expected to
receive | 354 |
at least one hundred new entrants during the first policy
year, | 355 |
and continues to receive not less than one hundred new
entrants to | 356 |
the group yearly, and only if the policy reserves to
the insurer | 357 |
the right to require evidence of individual
insurability if less | 358 |
than seventy-five per cent of the new
entrants become insured. The | 359 |
policy may exclude from the classes
eligible for insurance classes | 360 |
of debtors determined by age. | 361 |
(5) Life insurance covering the members of any duly
organized | 370 |
corporation or association of veterans or veteran
society or | 371 |
association of the World War veterans, written under a
policy | 372 |
issued to such corporation, association, or society which
is the | 373 |
employer for the purpose of such sections, the premium on
which is | 374 |
to be paid by the corporation, association, society, and
its | 375 |
members jointly, and insuring all of its members who are
actively | 376 |
engaged in any occupation for amounts of insurance based
upon some | 377 |
plan which will preclude individual selection for the
benefit of | 378 |
persons other than the corporation, association, or
society or its | 379 |
officials; provided that when the premium is to be
paid by the | 380 |
corporation, association, or society and its members
jointly and | 381 |
the benefits are offered to all eligible members, not
less than | 382 |
seventy-five per cent of such members may be insured;
and provided | 383 |
that when members apply and pay for additional
amounts of | 384 |
insurance, a smaller percentage of members may be
insured for such | 385 |
additional amounts if they pass satisfactory
medical examinations | 386 |
or submit satisfactory evidence of
insurability; | 387 |
(6) Life insurance covering the members of any
organization | 388 |
of agriculturists or horticulturists organized under
the | 389 |
co-operative laws of this state, written under a policy
issued to | 390 |
such co-operative association which is the employer for
the | 391 |
purpose of such sections, the premium on which is to be paid
by | 392 |
the association or by the association and its members jointly,
and | 393 |
insuring all of its members who are actively engaged in | 394 |
agricultural or horticultural pursuits, for an amount of
insurance | 395 |
based upon some plan which will preclude individual
selection, and | 396 |
for the benefit of persons other than the
association or its | 397 |
officials; provided that when the premium is
to be paid by the | 398 |
corporation, association, or society and its
members jointly and | 399 |
the benefits are offered to all eligible
members, not less than | 400 |
seventy-five per cent of such members may
be insured; provided | 401 |
that when members apply and pay for
additional amounts of | 402 |
insurance, a smaller percentage of members
may be insured for such | 403 |
additional amounts if they pass
satisfactory medical examinations | 404 |
or submit satisfactory evidence
of insurability; | 405 |
(7) Life insurance covering employees of a political | 406 |
subdivision or district of this state, or of an educational or | 407 |
other institution supported in whole or in part by public funds, | 408 |
or of any classes thereof, determined by conditions pertaining to | 409 |
employment, or of this state or any department or division | 410 |
thereof, written under a policy issued to such political | 411 |
subdivision, district, or institution, or the proper official or | 412 |
board of this state or of such state department or division | 413 |
thereof, which is the employer for the purpose of such sections, | 414 |
the premium on which is to be paid by such employees, unless | 415 |
otherwise provided by law, charter, or ordinance, for the benefit | 416 |
of persons other than the employer; provided that when the | 417 |
benefits of the policy are offered to all eligible employees of a | 418 |
political subdivision or district of the state or of an | 419 |
educational or other institution supported in whole, or in part
by | 420 |
public funds, or of this state or a state department or
division | 421 |
thereof, not less than seventy-five per cent of such
employees may | 422 |
be insured; and provided that when employees apply
and pay for | 423 |
additional amounts of insurance, a smaller percentage
of employees | 424 |
may be insured for such additional amounts if they
pass | 425 |
satisfactory medical examinations or submit satisfactory
evidence | 426 |
of insurability; and provided that upon acquisition by a
political | 427 |
subdivision of any privately owned property or
enterprise, the | 428 |
employees of which have been covered by a group
policy of life or | 429 |
other insurance as employees of such private
employer, such | 430 |
political subdivision and insurance company may
continue such | 431 |
contract in force upon similar conditions as the
last preceding | 432 |
private employer; | 433 |
(8) Life insurance covering the members, or the members
and | 434 |
the employees of members of any duly organized association,
other | 435 |
than an association subject to any other provision of this | 436 |
division, written under a policy issued to such association,
which | 437 |
association is the employer for the purpose of such
sections, the | 438 |
premium on which is to be paid by the insured
members or their | 439 |
employees, insuring members and their employees
for amounts of | 440 |
insurance based upon some plan which will preclude
individual | 441 |
selection except as provided in this section, for the
benefit of | 442 |
persons other than the association; provided the
association has | 443 |
been in existence for at least two years
immediately preceding the | 444 |
purchase of the insurance; provided
that there must be at least | 445 |
fifty insured members in any group;
and provided that the | 446 |
association has been organized and is
maintained in good faith for | 447 |
purposes other than that of
obtaining insurance; | 448 |
(C) A life insurance policy issued to a labor union or | 466 |
similar employee organization, which union or organization shall | 467 |
be deemed the policyholder, to insure members of the union or | 468 |
organization for the benefit of persons other than the union or | 469 |
organization or any of its officials, representatives, or agents, | 470 |
subject to all of the following requirements: | 471 |
(2) The premium for the policy is paid either from funds of | 475 |
the union or organization or from funds contributed by the insured | 476 |
members specifically for the members' insurance, or from both. | 477 |
Except as provided in division (C)(3) of this section, a policy on | 478 |
which no part of the premium is derived from funds contributed by | 479 |
the insured members specifically for the members' insurance shall | 480 |
insure all eligible members, except those members who reject the | 481 |
coverage in writing. | 482 |
(D) A life insurance policy issued to a trust or to the | 486 |
trustees of a trust fund
established jointly by one or more | 487 |
employers in the same
industry, on the one hand, andor adopted by | 488 |
two or more employees, or by one or more labor unions
representing | 489 |
as bargaining agents employees of such employers, on
the other | 490 |
hand, or by twoor similar employee organizations, or by one or | 491 |
more employers in the same industry,
or by twoand one or more | 492 |
labor unions or similar employee organizations, which trust or | 493 |
trustees shall be deemed
the policyholder, to insure employees of | 494 |
the employers or members
of the unions or similar employee | 495 |
organizations for the benefit of persons other than the employers | 496 |
or
the unions or the trusteesorganizations, subject to the | 497 |
following
requirements: | 498 |
(a)(1) The persons eligible for such insurance shall be all | 499 |
of the employees of the employers, or all of the members of the | 500 |
unions or organizations, or all of any class of such employees | 501 |
determined by sex,
age, or conditions pertaining to their | 502 |
employment, or to
membership in the unions, or to any or all of | 503 |
themor classes of the employees or members. The policy
may | 504 |
provide that "employees" includes the retired employees of
the | 505 |
employer and the officers, managers, employees, and retired | 506 |
employees of one or more subsidiary or affiliated corporations and | 507 |
the employees,
individual proprietors, and partners, employees, | 508 |
and retired
employees of affiliated individuals and firms, when | 509 |
the business
of such subsidiary orof one or more affiliated | 510 |
corporations, firms, or
individuals is controlled by the common | 511 |
employer through stock
ownership, contract, or otherwise | 512 |
proprietorships, or partnerships if the business of the employer | 513 |
and of the affiliated corporations, proprietorships, or | 514 |
partnerships is under common control. The policy may provide that | 515 |
"employees" includes the individual proprietor or partners if the | 516 |
employer is an individual proprietorproprietorship or a | 517 |
partnership. The policy
may provide that "employees" includes | 518 |
retired employees, former employees, and directors of a corporate | 519 |
employer. The policy may provide that "employees" includes the | 520 |
trustees or their
employees, or both, if their duties are | 521 |
principally connected
with suchthe trusteeship. | 522 |
(b)(2) The premium for the policy shall be paid by the | 523 |
trustees, either wholly from funds contributed by the employer or | 524 |
employers
of the insured persons, or partly from such funds and | 525 |
partly from
funds contributed by the insured employees. If part of | 526 |
the
premium is to be derived from funds contributed by the insured | 527 |
employees, then such policy may be placed in force only if it | 528 |
covers at least seventy-five per cent of the then eligible | 529 |
employees. Aor by the union or unions or similar employee | 530 |
organizations, or by both, or from funds contributed by the | 531 |
insured persons or from both the insured persons and the employers | 532 |
or unions or similar employee organizations. Except as provided in | 533 |
division (D)(3) of this section, a policy on which no part of the | 534 |
premium is derived
from funds contributed by the insured employees | 535 |
persons specifically for their insurance must insure all
eligible | 536 |
employees. | 537 |
(10) Life insurance covering the members of a credit
union, | 544 |
which shall be deemed to be the employer for the purposes
of this | 545 |
section, the premium on which is to be paid by the credit
union or | 546 |
by the credit union and its members jointly, and
insuring all of | 547 |
its eligible members for amounts of insurance not
in excess of the | 548 |
share balance as to each member, and for the
benefit of persons | 549 |
other than the credit union or its officers;
provided that in the | 550 |
determination of the eligibility of members
there may be | 551 |
classifications and limitations based upon age;
provided also that | 552 |
when the premium is to be paid by the credit
union and its members | 553 |
jointly and the benefits are offered to all
eligible members, not | 554 |
less than seventy-five per cent of such
members may be so insured; | 555 |
provided also that in obtaining such
insurance, the officers of | 556 |
the credit union shall consider
proposals from any licensed | 557 |
insurer; provided also that members
may be required to provide | 558 |
evidence of insurability satisfactory
to the insurer. | 559 |
(11) Life insurance covering the members of any duly | 560 |
organized corporation or association of members of the Ohio | 561 |
national guard, the Ohio naval militia, and the Ohio military | 562 |
reserve, which shall have been in existence for at least two
years | 563 |
immediately preceding the purchase of such insurance,
written | 564 |
under a policy issued to such corporation or association,
which | 565 |
corporation or association is the employer for the purpose
of such | 566 |
sections, the premium on which is to be paid by the
insured | 567 |
members, insuring members for amounts of insurance based
upon some | 568 |
plan which will preclude individual selection, except
as provided | 569 |
in this section, for the benefit of persons other
than the | 570 |
corporation or association, provided that there must be
at least | 571 |
fifty insured members in any group, and provided further
that | 572 |
unless seventy-five per cent of all members or one thousand | 573 |
members, whichever is the lesser number, are insured, each member | 574 |
must pass a satisfactory medical examination in order to be | 575 |
insured; and provided that, when members apply and pay for | 576 |
additional amounts of insurance, they may be insured for such | 577 |
additional amounts if they pass satisfactory medical examinations | 578 |
or submit satisfactory evidence of insurabilitypersons, except | 579 |
those persons who reject the coverage in writing. | 580 |
(E) A life insurance policy issued to an association or to a | 584 |
trust or the trustees of a fund established, created, or | 585 |
maintained for the benefit of members of one or more associations, | 586 |
which association, trust or trustee, or an agent, shall be deemed | 587 |
the policyholder, subject to all of the following requirements: | 588 |
(a) The policy may insure one or more of the members of the | 604 |
association or associations, employees of the association or | 605 |
associations, or employees of members, or all of any class or | 606 |
classes of the employees or members of the association or | 607 |
associations, and employees of the members of the association or | 608 |
associations, for the benefit of persons other than an employee's | 609 |
employer. | 610 |
(F) A life insurance policy issued to a credit union or to a | 625 |
trustee or trustees or agent designated by two or more credit | 626 |
unions, which credit union, trustee, trustees, or agent shall be | 627 |
deemed the policyholder, to insure the members of the credit union | 628 |
or credit unions for the benefit of persons other than the credit | 629 |
union or credit unions, trust or trustees, or agents or officials | 630 |
of the credit union or credit unions or trust, subject to all of | 631 |
the following requirements: | 632 |
(12)(G) Life insurance that is written under a policy
issued | 642 |
to a trustee under a trust established by an insurer for
the | 643 |
purpose of providing continued group life insurance coverage
to | 644 |
those former employees,
former members, or former members and the | 645 |
employees of such members, and their
spouses and dependent | 646 |
childrendependents,
previously covered under policies of group | 647 |
life insurance issued
by the insurer to employers or trustees | 648 |
pursuant to
division (A) of this section, to associations pursuant | 649 |
to division
(B)(8)(D) of this section, or to trustees pursuant to | 650 |
division
(B)(9)(E) of this section, or to groups pursuant to | 651 |
division (I) of this section, and
that is evidenced by the | 652 |
issuance of a certificate of insurance or other evidence of | 653 |
insurance
to such former employees or members as required by | 654 |
section 3917.06 of the Revised Code; provided that the amount of | 655 |
the continued
life
insurance coverage made available to a former | 656 |
employee or member and to
the employee's or member's spouse and | 657 |
dependents shall not exceed the amount
of the group life insurance | 658 |
coverage previously provided to
the employee or member and the | 659 |
employee's or member's eligible dependents at
the time
of the | 660 |
employee's separation from employment or the member's termination | 661 |
of
membership. | 662 |
(13)(H) Life insurance covering the members of a workforce | 663 |
actively engaged in an occupation for, and performing services on | 664 |
behalf of, a duly organized corporation, limited liability | 665 |
company, partnership, proprietor, or a similar organization, whose | 666 |
members are not employees of the organization, written under a | 667 |
policy issued to the organization, which organization is the | 668 |
members' employer for this purpose, the premium on which is to be | 669 |
paid by the organization or by the organization and the members | 670 |
jointly, insuring members for amounts of insurance based upon some | 671 |
plan which will preclude individual selection, for the benefit of | 672 |
persons other than the organization; provided, that when the | 673 |
premium is to be paid by the organization and its members jointly | 674 |
and the benefits are offered to all eligible members, not less | 675 |
than seventy-five per cent of the members may be so insured; | 676 |
provided also that members may be required to furnish evidence of | 677 |
insurability satisfactory to the insurer. Life insurance meeting | 678 |
this definition may also cover the organization's employees at the | 679 |
option of the organization. | 680 |
(C) Any policy issued pursuant to this section, except a | 681 |
policy issued to a creditor pursuant to division (B)(4) of this | 682 |
section, may be extended, in the form of group term life
insurance | 683 |
only, to insure the spouse and dependent children of an
insured | 684 |
employee or member, or any class or classes thereof,
subject to | 685 |
the following requirements: | 686 |
(B) With respect to a program of life insurance that, if | 739 |
issued on a group basis, would not qualify as a policy of group | 740 |
life insurance under divisions (A) to (H) of section 3917.01 of | 741 |
the Revised Code, the insurer shall distribute a written notice to | 742 |
prospective insureds that compensation will or may be paid, if | 743 |
compensation of any kind will or may be paid, to one of the | 744 |
following persons: | 745 |
(C) The insurer shall distribute the notice required by this | 751 |
section whether the potential compensation is direct or indirect | 752 |
and whether the compensation is paid to or retained by the | 753 |
policyholder or sponsoring or endorsing entity or paid to or | 754 |
retained by a third party, or an entity affiliated with the third | 755 |
party by way of ownership, contract, or employment, at the | 756 |
direction of the policyholder or sponsoring or endorsing entity. | 757 |
Sec. 3917.03. Any life insurance policy issued pursuant to | 761 |
section 3917.01 of the Revised Code, except for a policy issued | 762 |
pursuant to division (B) of section 3917.01 of the Revised Code, | 763 |
may be extended to insure an employee's dependents or member's | 764 |
dependents, as defined by the policy, or any class or classes of | 765 |
dependents, subject to the following: | 766 |
(A) The premium for the insurance shall be paid either from | 767 |
the funds contributed by the employer, union, association, or | 768 |
other person to whom the policy has been issued, or from funds | 769 |
contributed by the covered persons, or from both. Except as | 770 |
provided in division (B) of this section, a policy on which no | 771 |
part of the premium for the dependent's coverage is derived from | 772 |
funds contributed by the covered persons shall insure the | 773 |
dependents of all eligible employees or members, or a class or | 774 |
classes of dependents. | 775 |
Sec. 3917.06. NoExcept as provided in division (M) of this | 779 |
section, no policy of group life insurance shall be
issued or | 780 |
delivered in this state until a copy of its form has
been filed | 781 |
with the superintendent of insurance and formally
approved by the | 782 |
superintendent; nor shall such policy be so
issued or delivered | 783 |
unless it contains in substance the following provisions or other | 784 |
provisions, that in the opinion of the superintendent of insurance | 785 |
are more favorable to the persons insured, or at least as | 786 |
favorable to the persons insured and more favorable to the | 787 |
policyholder: | 788 |
(A) A provision that the policyholder is entitled to a
grace | 789 |
period of thirty-one days for the payment of any premiums
due | 790 |
except the first, during which grace period the death benefit | 791 |
coverage shall continue in force, unless the policyholder has | 792 |
given the insurer written notice of discontinuance in advance of | 793 |
the date of discontinuance and in accordance with the terms of
the | 794 |
policy; the policy may provide that the policyholder is
liable to | 795 |
the insurer for the payment of a pro rata premium for
the time the | 796 |
policy was in force during such grace period; | 797 |
(B) A provision that the policy is incontestable after two | 798 |
years from its date of issue, except for nonpayment of premiums | 799 |
and except for violation of the conditions of the policy relating | 800 |
to military or naval service in time of war;. No statement made by | 801 |
any individual insured under the policy relating to the | 802 |
individual's insurability shall be used in contesting the validity | 803 |
of the insurance, with respect to which the statement was made, | 804 |
that has been in force prior to the contest for a period of two | 805 |
years during the individual's life, unless the statement is | 806 |
contained in a written instrument signed by the individual. This | 807 |
division does not preclude the assertion at any time of defenses | 808 |
based upon provisions in the policy that relate to eligibility for | 809 |
coverage. | 810 |
(C) A provision requiring that the policy anda copy of the | 811 |
application
submitted in connection therewith constitute the | 812 |
entire contract
between the partiesof the policyholder, if any, | 813 |
be attached to the policy when issued, and that all statements | 814 |
contained in such
application are deemed, in the absence of fraud, | 815 |
made by the policyholder and individuals insured shall be deemed | 816 |
representations
and not warranties, and that no such statement | 817 |
made by any person insured shall be used in
defense to a claim | 818 |
under the policy, unless it is contained in a
written application | 819 |
any contest unless a copy of the instrument containing the | 820 |
statement is furnished to the insured, or in the event of the | 821 |
death or incapacity of the insured, to the insured's beneficiary | 822 |
or personal representative; | 823 |
(F) A provision requiring that any sum becoming due by reason | 837 |
of the death of the insured be payable to the beneficiary | 838 |
designated by the insured. However, if the policy contains | 839 |
conditions pertaining to family status, the beneficiary may be the | 840 |
family member specified by the policy terms, subject to the | 841 |
provisions of the policy in the event that there is no designated | 842 |
beneficiary living at the time of the death of the insured as to | 843 |
all or any part of the sum, and subject to any right reserved in | 844 |
the policy by the insurer and set forth in the certificate to pay, | 845 |
at the insurer's option, a part of the sum not exceeding two | 846 |
thousand dollars to any beneficiary that the insurer believes is | 847 |
equitably entitled to the amount by reason of having incurred | 848 |
funeral or other expenses incident to the last illness or death of | 849 |
the insured. | 850 |
(G) A provision that
the companyinsurer will issue to the | 851 |
policyholder for delivery to each
person whose life is insured | 852 |
under such policy, an individuala
certificate setting forth a | 853 |
statement as to the insurance
protection to which the person is | 854 |
entitled, any dependent's coverage, to whom benefits are payable, | 855 |
together withand the rights and conditions set forth in divisions | 856 |
(H) to (K) of this section. The policyholder may issue a single | 857 |
certificate for delivery to an insured employee or member if a | 858 |
statement concerning any dependent's coverage is included in the | 859 |
certificate. | 860 |
(H)(1) A provision to the effect that in case ofif all or | 861 |
any part of the insurance on an insured or an insured's dependents | 862 |
ceases because of the termination of
the employment for any reason | 863 |
or of membership in the class or classes
eligible for insurance | 864 |
coverage under the policy, such person is entitled
to have issued | 865 |
to the person by the companyinsurer, without
evidence of | 866 |
insurability, and upon application made to the companyan | 867 |
individual policy of life insurance without disability or | 868 |
supplementary benefits, provided that application for the | 869 |
individual policy is made, and the first premium is paid to the | 870 |
insurer, within
thirty-one days after such termination, and upon | 871 |
the payment of
the premium applicable to the class of risk to | 872 |
which the
person belongs and to the form and amount of the policy | 873 |
at
the person's then attained age, either a policy of life | 874 |
insurance inprovided that all of the following conditions are | 875 |
met: | 876 |
(a) The individual policy is on any one
of the forms | 877 |
customarily issued by the company, except term insurance, in any | 878 |
amount not in excess of the amount of the person's
protection | 879 |
under the group insurance policy at the time of
the termination, | 880 |
as the person elects or, if applicable, the coverage
described in | 881 |
division (B)(12) of section 3917.01 of the Revised Code; | 882 |
(b) The individual policy is in an amount not in excess of | 886 |
the amount of life insurance that ceases because of termination, | 887 |
less the amount of any life insurance for which the person is | 888 |
eligible under the same or any other group policy within | 889 |
thirty-one days after termination, provided that any amount of | 890 |
life insurance that matures on or before the date of termination | 891 |
as an endowment payable to the insured, whether in one sum, | 892 |
installments, or in the form of an annuity, shall not, for | 893 |
purposes of this division, be included in the amount that is | 894 |
considered to cease because of termination. | 895 |
(3) If the individual is not given notice of the right to | 912 |
obtain individual coverage under this division at least fifteen | 913 |
days prior to the expiration of the thirty-one-day conversion | 914 |
period provided by division (H)(1) of this section then the | 915 |
individual shall have an additional period to exercise that right. | 916 |
This additional period shall extend for fifteen days after the | 917 |
individual is given notice, but in no event shall the period | 918 |
extend beyond sixty days after the expiration date of the period | 919 |
provided in the policy. Written notice provided to the individual | 920 |
or mailed by the policyholder to the last known address of the | 921 |
individual, or mailed by the insurer to the last known address of | 922 |
the individual furnished to the insurer by the policyholder, | 923 |
constitutes notice for purposes of this division. | 924 |
(I) A provision that if the group policy terminates or is | 928 |
amended so as to terminate the insurance of any class of insured | 929 |
persons, every person insured thereunder at the date of such | 930 |
termination whose insurance terminates, including an insured's | 931 |
dependent, and who has been so
insured for at least five years | 932 |
prior to such termination date is
entitled to have issued to the | 933 |
person by the insurer an
individual policy of life insurance, | 934 |
subject to the same conditions and limitations as are
provided by | 935 |
division (E)(H) of this section, except that the group
policy may | 936 |
provide that the amount of such individual policy
shall not exceed | 937 |
the smaller of (1) the amount of the person's
life insurance | 938 |
protection ceasing because of the termination
or amendment of the | 939 |
group policy, less the amount of any life
insurance for which the | 940 |
person is or becomes eligible under
any group
policy issued or | 941 |
reinstated by the same or another insurer within
thirty-one days | 942 |
after such termination, and (2) twoten thousand
dollars; | 943 |
(G)(J) A provision that if a person insured under the group | 944 |
policy, or an insured's dependent, dies during the period within | 945 |
which the person would
have been entitled to have an individual | 946 |
policy issued to the
person in accordance with division (E)(H) or | 947 |
(F)(I) of this section, and before
such an
individual policy has | 948 |
become effective, the amount of life
insurance which the person | 949 |
would have been entitled to have
issued to the person under such | 950 |
individual policy shall be
payable as a claim under the group | 951 |
policy, whether or not application for the
individual policy or | 952 |
the payment of the first premium therefor has been
made; | 953 |
Policies of group life insurance, when issued in this state | 962 |
by any company not organized under the laws of this state, may | 963 |
contain, when issued, any provision required by the law of the | 964 |
state, territory, or district of the United States under which
the | 965 |
company is organized; and policies issued in other states or | 966 |
countries by companies organized in this state, may contain any | 967 |
provision required or permitted by the laws of the state, | 968 |
territory, district, or country in which the same are issued.
Any | 969 |
such policy may be issued or delivered in this state which in
the | 970 |
opinion of the superintendent contains provisions on any one
or | 971 |
more of the requirements of this section more favorable to the | 972 |
policyholder or to the person whose life is insured under such | 973 |
policy than such requirements. | 974 |
(K) Where active employment is a condition of insurance, a | 983 |
provision that an insured may continue coverage during the | 984 |
insured's total disability by timely payment to the policyholder | 985 |
of that portion, if any, of the premium that would have been | 986 |
required from the insured if the insured's total disability had | 987 |
not occurred. The continuation shall be on a premium basis for a | 988 |
period of six months after the date on which the insured's total | 989 |
disability started, but not later than the earlier of either of | 990 |
the following: | 991 |
Sec. 3917.07. No provision in section 3917.06 of the Revised | 1039 |
Code shall
prohibit a person whose life is insured under any such | 1040 |
policy of group life
insurance from making an assignment of all or | 1041 |
any part of histhe
person's incidents of ownership under such | 1042 |
policy including specifically,
but not by way of limitation, any | 1043 |
right to designate a beneficiary or
beneficiaries thereunder and | 1044 |
any right to have an individual policy issued to
himthe person in | 1045 |
accordance with
division (E)(H) or (F)(I) of section 3917.06 of | 1046 |
the Revised Code. Subject to the
terms of the policy relating to | 1047 |
assignment of incidents of ownership
thereunder, such an | 1048 |
assignment by an insured, made either before or after the | 1049 |
effective date of this section, is valid for the purpose of | 1050 |
vesting in the
assignee, in accordance with any provisions | 1051 |
included therein as to the time at
which it is to be effective, | 1052 |
all of such incidents of ownership so assigned,
but without | 1053 |
prejudice to the insurer on account of any payment it may make or | 1054 |
individual policy it may issue in accordance with division (E)(H) | 1055 |
or (F)(I) of
section 3917.06 of the Revised Code prior to receipt | 1056 |
of notice of the
assignment. | 1057 |