Ohio Health Insurance Laws and Regulations

Comprehensive practice flashcards covering Ohio-specific insurance laws, licensing requirements, trade practices, and health insurance regulations.

Superintendent of Insurance

The chief executive officer and director of the Ohio Department of Insurance, responsible for enforcing insurance regulations and laws.

Cease and Desist Orders

Orders served by the Superintendent to agents or entities discovered engaging in unfair or deceptive practices or violating insurance statutes.

Certificate of Authority

A document secured from the Insurance Department required for insurance companies to operate legally within the state.

Agent

In Ohio, a licensed person permitted to solicit, receive, and submit insurance applications, serving as the main contact for policyholders.

License Renewal Requirements

A biennial process requiring a payment of a $25$ fee, a renewal application, and evidence of completed continuing education before the end of the agent's birth month.

Continuing Education (CE)

The requirement for agents to complete $24$ hours of training biennially for each type of authority held, including at least $3$ hours of ethics.

Controlled Business

Insurance transactions involving the personal interests of the licensee, their employer, or immediate family members like spouses, children, or parents.

Reporting of Actions

The obligation for agents to inform the Superintendent within $30$ days regarding personal bankruptcy, felony convictions, or administrative actions.

Assumed Names

Names other than an agent's legal name used for operations; agents must inform the Superintendent prior to use.

Rebating

An illegal practice where a life insurance agent or company promises special favors or items of value as an incentive for purchasing insurance.

Misrepresentation

The illegal act of falsely representing policy terms, benefits, costs, effective dates, or the existence of the policy itself.

False Advertising

Misleading statements about insurance products, services, or the financial status of an insurer.

Defamation of Insurer

The unlawful dissemination of false or unsupported negative information intended to cause harm to an insurance company.

Unfair Discrimination

The illegal practice of charging varying premiums to individuals within the same risk category.

Admitted Insurer

An insurance company officially authorized and holding a Certificate of Authority to offer products in the state.

Non-admitted Insurer

An insurance provider unauthorized to sell insurance because they have been refused or have not applied for a Certificate of Authority.

Viatical Settlements

A transaction where a policy owner sells their life insurance policy to another party for a payment less than the expected death benefit.

Entire Contract

A provision stating the policy alongside the application constitutes the complete agreement between the insured and the insurer.

Incontestability

A policy provision making terms deemed incontestable after being in effect for $2$ years, except in cases of fraudulent intent.

Payment of Claims (Life)

The requirement that death benefits be disbursed within $2$ months following the receipt of the death certificate.

Buyer's Guide

A document that assists applicants in evaluating and selecting the most suitable life insurance policy for their needs.

Resident Insurance Agent License Criteria

Requires applicant to be at least $18$ years old, complete a $20$-hour pre-licensing course per line, pass the state exam, and pass a criminal background check.

Temporary License

A license issued for up to $180$ days under special circumstances like the death, disability, or military service of an agent to ensure business continuity.

Inactive Status

A status requested by licensees not engaging in insurance activities for upcoming $24$ months, which exempts them from continuing education requirements.

License Surrender for Cause

A voluntary surrender of license that bars an individual from reapplying for at least $5$ years.

Negotiate

Discussing or advising consumers on substantive benefits, terms, or conditions of a specific insurance product.

Solicit

The attempt to sell insurance or encourage/persuade a person to apply for a specific type of insurance from a designated insurer.

Domestic Insurance Company

A company that resides and is incorporated under the laws of the state in which its home office is located.

Foreign Insurance Company

A company whose home office is located in another U.S. state or territory besides Ohio.

Alien Insurance Company

A company chartered and headquartered in any country other than the United States.

Insolvency

A condition where an insurer cannot meet financial obligations when due or admitted assets are less than liabilities plus required capital.

Unfair Claims Settlement (Investigation Timeframe)

Failure to initiate a reasonable investigation of a claim within $21$ days after receiving notice of the claim.

Claim Records Retention

Insurers must retain records of closed claims for at least $3$ years or until the next financial examination, whichever is longer.

Cybersecurity Event

An incident involving unauthorized access to or misuse of an information system affecting nonpublic information likely to cause material harm.

Fair Credit Reporting Act (FCRA)

A federal law regulating the use and disclosure of consumer credit information by reporting agencies and insurers.

Section 1033 Waiver

Permission from a state insurance regulator required for an individual convicted of insurance-related fraud to re-engage in the business.

Ohio Children’s Health Insurance Program (CHIP)

A program providing low-cost or free health insurance for children under $19$ from families earning below $150\%$ of the federal poverty level.

Creditable Coverage

Prior coverage under another health plan that can shorten a waiting period for pre-existing conditions, provided there was no lapse over $63$ days.

Continuation of Coverage (Ohio Law)

Requires employers with fewer than $20$ employees to offer terminated employees continued accident and health coverage for at least $12$ months.

Health Insuring Corporation (HIC)

The term used in Ohio to refer to Health Maintenance Organizations (HMOs).

Small Employer

Defined in Ohio as an entity employing between $2$ and $50$ individuals.

Twisting

The use of false representations or incorrect comparisons to convince someone to cancel or modify an existing policy in favor of a new one.

Cold Lead Advertising

A prohibited marketing technique that fails to clearly state that the purpose of contact is insurance solicitation.

ACA Metal Levels

Benefit tiers that specify the actuarial level covered: Bronze ($60\%$), Silver ($70\%$), Gold ($80\%$), and Platinum ($90\%$).

Grandfathered Plans

Health plans purchased before March $23$, $2010$, which are exempt from many Affordable Care Act (ACA) guidelines.

Endodontics

The field of dentistry focused on diseases affecting the dental pulp, commonly including root canal treatments.

Periodontics

The specialty dealing with the tissues supporting and surrounding teeth, such as the gums.

Prosthodontics

The replacement of missing dental or oral parts using biocompatible materials like bridgework or dentures.

Donut Hole

A gap in Medicare Part D coverage where the insured is responsible for a higher portion of drug costs after reaching a certain limit.

Blanket Sickness and Accident Insurance

Coverage for specific groups exposed to unique hazards, such as common carrier passengers, volunteer fire departments, or students.