Ohio Code 1731.09 – Application of chapter 3924 – alliance business class
(A) Nothing contained in this chapter is intended to or shall inhibit or prevent the application of the provisions of Chapter 3924 of the Revised Code to any health benefit plan or insurer to which they would otherwise apply in the absence of this chapter, except as otherwise specified in divisions (B) and (C) of this section or unless such application conflicts with the provisions of section 1731.05 of the Revised Code.
Terms Used In Ohio Code 1731.09
- Health benefit plan: means any hospital or medical expense policy of insurance or a health care plan provided by an insurer, including a health insuring corporation plan, provided by or through an insurer, or any combination thereof. See Ohio Code 1731.01
- Insurer: means an insurance company authorized to do the business of sickness and accident insurance in this state or, for the purposes of this chapter, a health insuring corporation authorized to issue health care plans in this state. See Ohio Code 1731.01
(B) An insurer may establish one or more separate classes of business solely comprised of one or more alliances. All of the following shall apply to health plans covering small employers in each class of business established pursuant to this division:
(1) The premium rate limitations set forth in section 3924.04 of the Revised Code apply to each class of business separate and apart from the insurer’s other business;
(2) For purposes of applying sections 3924.01 to 3924.14 of the Revised Code to a class of business, the base premium rate and midpoint rate shall be determined with respect to each class of business separate and apart from the insurer’s other business.
(3) The midpoint rate for a class of business shall not exceed the midpoint rate for any other class of business or the insurer’s non-alliance business by more than fifteen per cent.
(4) The insurer annually shall file with the superintendent of insurance an actuarial certification consistent with section 3924.06 of the Revised Code for each class of business demonstrating that the underwriting and rating methods of the insurer do all of the following:
(a) Comply with accepted actuarial practices;
(b) Are uniformly applied to health benefit plans covering small employers within the class of business;
(c) Comply with the applicable provisions of this section and sections 3924.01 to 3924.14 of the Revised Code.
(5) An insurer shall apply sections 3924.01 to 3924.14 of the Revised Code to the insurer’s non-alliance business and coverage sold through alliances not established as a separate class of business.
(6) An insurer shall file with the superintendent a notification identifying any alliance or alliances to be treated as a separate class of business at least sixty days prior to the date the rates for that class of business take effect.
(7) Any application for a certificate of authority filed pursuant to section 1731.021 of the Revised Code shall include a disclosure as to whether the alliance will be underwritten or rated as part of a separate class of business.
(C) As used in this section:
(1) “Class of business” means a group of small employers, as defined in section 3924.01 of the Revised Code, that are enrolled employers in one or more alliances.
(2) “Actuarial certification,” “base premium rate,” and “midpoint rate” have the same meanings as in section 3924.01 of the Revised Code.