Ohio Revised Code
Chapter 3923 | Sickness and Accident Insurance
Section 3923.121 | Association of Insurers to Provide Basic Medical Coverage to Persons 65 or Older.

Effective: September 1, 2002
Latest Legislation: Senate Bill 129 - 124th General Assembly
(A) As used in this section:
(1) "Association" means a voluntary unincorporated association of insurers formed for the sole purpose of enabling cooperative action to provide sickness and accident insurance in accordance with this section.
(2) "Insurer" means any insurance company authorized to do the business of sickness and accident insurance in this state.
(3) "Insured" means a person covered under a group policy issued pursuant to this section.
(B) Any insurer may join with one or more other insurers, in an association, to offer, sell, and issue to a policyholder selected by the association a policy of group insurance against major financial loss from sickness and accident covering residents of this state who are sixty-five years of age or older and the spouses of such residents. The insurance shall be offered, issued, and administered in the name of the association. Membership in the association shall be open to any insurer and each insurer which participates shall be liable for a specified percentage of the risks. The policy may be executed on behalf of the association by a duly authorized person and need not be countersigned by an agent.
(C) The persons eligible for coverage under the policy shall be all residents of this state who are sixty-five years of age or older and their spouses, subject to reasonable underwriting restrictions to be set forth in the plan of the association. The policy may provide basic hospital and surgical coverage, basic medical coverage, major medical coverage, and any combination of these; provided that it shall not be required as a condition for obtaining major medical coverage that any basic coverage be taken.
(D) The association shall file with the superintendent of insurance any policy, contract, certificate, or other evidence of insurance, application, or other forms pertaining to such insurance together with the premium rates to be charged therefor. The superintendent may approve, disapprove, and withdraw approval of the forms in accordance with section 3923.02 of the Revised Code, or the premium rates if by reasonable assumptions such rates are excessive in relation to the benefits provided. In determining whether such rates by reasonable assumptions are excessive in relation to the benefits provided the superintendent shall give due consideration to past and prospective claim experience, within and outside this state, and to fluctuations in such claim experience, to a reasonable risk charge, to contribution to surplus and contingency funds, to past and prospective expenses, both within and outside this state, and to all other relevant factors within and outside this state, including any differing operating methods of the insurers joining in the issuance of the policy. In reviewing the forms the superintendent shall not be bound by the requirements of sections 3923.04 to 3923.07 of the Revised Code with respect to standard provisions to be included in sickness and accident policies or forms.
(E) The association may enroll eligible persons for coverage under the policy through any insurance agent licensed to sell sickness and accident insurance pursuant to Chapter 3905. of the Revised Code or section 3941.02 of the Revised Code.
(F) The association shall file annually with the superintendent on such date and in such form as the superintendent may prescribe, a financial summary of its operations.
(G) The association may sue and be sued in its associate name and for such purposes only shall be treated as a domestic corporation. Service of process against the association made upon a managing agent, any member thereof, or any agent authorized by appointment to receive service of process, shall have the same force and effect as if the service had been made upon all members of the association.
(H) Under any policy issued as provided in this section, the policyholder, or such person as the policyholder shall designate, shall alone be a member of each domestic mutual insurance company joining in the issue of the policy and shall be entitled to one vote by virtue of such policy at the meetings of each such mutual insurance company. Notice of the annual meetings of each such mutual insurance company may be given by written notice to the policyholder or as otherwise prescribed in the policy.

Structure Ohio Revised Code

Ohio Revised Code

Title 39 | Insurance

Chapter 3923 | Sickness and Accident Insurance

Section 3923.01 | Policy of Sickness and Accident Insurance Defined.

Section 3923.011 | Sickness and Accident Insurance Definitions.

Section 3923.02 | Form of Policy Filed With Superintendent.

Section 3923.021 | Approval or Disapproval of Premium Rates.

Section 3923.022 | Maximum Aggregate Administrative Expenses.

Section 3923.03 | Necessary Provisions.

Section 3923.04 | Policy Standard Provisions.

Section 3923.041 | Policies With Prior Authorization Requirement Provisions.

Section 3923.05 | Provisions to Conform to Prescribed Wording.

Section 3923.06 | Order of Presentation of Policy Provisions.

Section 3923.061 | Interest on Proceeds Payable Due to Death by Sickness or Accident.

Section 3923.07 | Omission or Substitution of Provisions.

Section 3923.071 | Policies, Applications, Riders or Indorsements Issued Prior to 10-1-53.

Section 3923.08 | Nonconflicting Provisions Permitted in Policy.

Section 3923.09 | Validity of Nonconforming Policy.

Section 3923.10 | Industrial Sickness and Accident Insurance.

Section 3923.11 | Sickness and Accident Insurance on a Franchise Plan.

Section 3923.12 | Group Sickness and Accident Insurance.

Section 3923.121 | Association of Insurers to Provide Basic Medical Coverage to Persons 65 or Older.

Section 3923.122 | [Suspended Eff. 1/1/2014 to 1/1/2026, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Option for Conversion From Group Policy to Individual Policy.

Section 3923.123 | Association of Insurers to Provide Group Health Coverage to Qualified Unemployed Persons.

Section 3923.13 | Blanket Sickness and Accident Insurance.

Section 3923.14 | False Statement in Application - Alteration of Written Application.

Section 3923.141 | Agent of the Insurer.

Section 3923.15 | Unfair Discrimination Prohibited.

Section 3923.16 | Misleading or Deceptive Advertising Prohibited.

Section 3923.161 | Describing Cancellability and Renewability Provisions Clearly and With Prominence or Emphasis.

Section 3923.17 | Prohibition of Rebates Not to Prohibit Commissions or Dividends.

Section 3923.18 | Rights of Insurer in Defense of Claim Not Waived.

Section 3923.19 | Benefits Exempt From Legal Process - Exception.

Section 3923.20 | Exemptions for Certain Insurance Policies.

Section 3923.21 | Prohibition Against Delivery of Policy on Disapproved Insurance Form.

Section 3923.22 | Appeal - Applicability of Administrative Procedure Sections.

Section 3923.23 | Reimbursement for Services of Licensed Osteopath, Optometrist, Chiropractor or Podiatrist.

Section 3923.231 | Reimbursement for Services of Licensed Psychologist.

Section 3923.232 | Reimbursement for Services of Licensed Dentist.

Section 3923.233 | Reimbursement for Services of Certified Nurse-Midwife Performing Service in Collaboration With Licensed Physician.

Section 3923.234 | Reimbursement for Services of Certified Mechanotherapist.

Section 3923.24 | Continuing Coverage for Dependent Children.

Section 3923.241 | Public Employee Benefit Plans - Continuing Coverage for Dependent Children.

Section 3923.25 | Kidney Dialysis Benefits.

Section 3923.26 | Coverage for Newly Born Children From the Moment of Birth.

Section 3923.27 | Hospitalization Coverage for Mental Illness.

Section 3923.28 | Outpatient Coverage for Mental or Emotional Disorders.

Section 3923.281 | Sickness and Accident Policies - Biologically Based Mental Illness.

Section 3923.282 | Health Coverage Plans - Biologically Based Mental Illness.

Section 3923.29 | Outpatient, Inpatient, and Intermediate Primary Care Benefits for Alcoholism.

Section 3923.30 | Requiring Provision of Coverage of Treatment of Mental or Nervous Disorders and Alcoholism.

Section 3923.301 | Requiring Provision of Coverage for Services of Certified Nurse-Midwife Performing Service in Collaboration With Licensed Physician.

Section 3923.31 | Right to Rescind Individual Policy of Sickness and Accident Insurance.

Section 3923.32 | Right of Family Member to Continue Coverage After Subscriber's Death or Upon Change in Marital Relation to Subscriber.

Section 3923.33 | Medicare Supplement Policy Definitions.

Section 3923.331 | Statutes Applicable to Medicare Supplement Policies.

Section 3923.332 | Standards for Policy Provisions of Medicare Supplement Policies and Certificates.

Section 3923.333 | Benefits to Be Reasonable in Relation to Premium Charged.

Section 3923.334 | Outline of Coverage Delivered at Time Application Is Made.

Section 3923.335 | Right to Return Policy or Certificate and Have Premium Refunded.

Section 3923.336 | Review and Approval of Advertisement by Superintendent.

Section 3923.337 | Rules.

Section 3923.338 | Orders of Superintendent.

Section 3923.339 | Severability.

Section 3923.36 | Excluding Coverage of Illness or Injury Covered by Workers' Compensation.

Section 3923.37 | Prohibiting Exclusion or Reduction of Benefits Because of Benefits Payable Under Supplemental Policy.

Section 3923.38 | Continuing Policy Upon Termination of Employment.

Section 3923.381 | Continuing Coverage Under Group Policy When Reservist Is Called or Ordered to Active Duty.

Section 3923.382 | Continuing Coverage Under Group Plan When Reservist Is Called or Ordered to Active Duty.

Section 3923.39 | Consolidated Corporation Cancelling Individual Policy for Nonpayment.

Section 3923.40 | Coverage of Adopted Children.

Section 3923.41 | Long-Term Care Insurance Definitions.

Section 3923.42 | Citing Provisions - Applicability.

Section 3923.43 | Evidence to Be Filed by Long-Term Care Insurance Association.

Section 3923.44 | Standards for Full and Fair Disclosure for Sale of Long-Term Care Insurance Policies.

Section 3923.441 | Rescission of Long-Term Care Policy for Misrepresentation.

Section 3923.442 | Offer of Nonforfeiture Benefit Option With Long-Term Care Policy.

Section 3923.443 | Training Required for Agents Selling Long-Term Care Policies.

Section 3923.444 | Compensation of Agents Selling Long-Term Care Policies.

Section 3923.45 | Forms.

Section 3923.46 | Rates for Individual Policy.

Section 3923.47 | Rules.

Section 3923.48 | Violation Is Unfair and Deceptive Insurance Practice.

Section 3923.49 | Establishing Outreach Program to Educate Consumers.

Section 3923.50 | Notifying Department of Job and Family Services of Long-Term Care Insurance Policies That Comply With Insurance Department Requirements.

Section 3923.51 | Group Contracts of Sickness and Accident Insurance Persons Under Nineteen Who Are Members of Impoverished Families.

Section 3923.52 | Screening Mammography and Cytologic Screening Benefits.

Section 3923.53 | Public Employee Benefit Plan - Breast Cancer and Cervical Cancer Screening.

Section 3923.54 | Employee Health Care Benefit Plan.

Section 3923.55 | Policy to Include Benefits for Child Health Supervision Services From Moment of Birth Until Age Nine.

Section 3923.56 | Plan to Include Benefits for Child Health Supervision Services From Moment of Birth Until Age Nine.

Section 3923.57 | Pre-Existing Conditions Provisions.

Section 3923.571 | Conditions Applying to Group Policies of Sickness and Accident Insurance Sold in Connection With Employment-Related Group Health Plan.

Section 3923.58 | [Suspended Eff. 1/1/2014 to 1/1/2026, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Open Enrollment Coverage - Insurers in the Business of Issuing Individual Policies of Sickness and Accident Insurance.

Section 3923.581 | [Suspended Eff. 1/1/2014 to 1/1/2026, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Open Enrollment Coverage - Carriers in the Business of Issuing Health Benefit Plans to Individuals or Nonemployer Groups.

Section 3923.582 | [Suspended Eff. 1/1/2014 to 1/1/2026, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Open Enrollment Coverage - Responsibilities of Superintendent of Insurance.

Section 3923.59 | [Suspended Eff. 1/1/2014 to 1/1/2026, per Section 3 of s.b. 9 of the 130th General Assembly, as Amended] Open Enrollment Reinsurance Program.

Section 3923.60 | Standard Medical Reference Compendia for Coverage of Prescription Drugs.

Section 3923.601 | Standardized Prescription Identification Information - Pharmacy Benefits to Be Included.

Section 3923.602 | Medication Synchronization for Insured.

Section 3923.61 | Public Employee Benefit Plans - Prescription Drugs.

Section 3923.62 | Disclosing Determination of Usual and Customary Fee for Dental Benefits.

Section 3923.63 | Coverage of Inpatient Care and Follow-Up Care for Mother and Her Newborn.

Section 3923.64 | Public Employee Benefit Plans - Maternity Benefits.

Section 3923.65 | Coverage for Emergency Services.

Section 3923.80 | Denial of Coverage to Cancer Clinical Trial Participant.

Section 3923.81 | Covered Person's Payments Not to Exceed Insurer Payments.

Section 3923.82 | Coverage for Alcohol or Drug Related Losses or Expenses.

Section 3923.83 | Standardized Prescription Identification Information - Pharmacy Benefits to Be Included - Public Employee Benefit Plan.

Section 3923.84 | Coverage for Autism Spectrum Disorder.

Section 3923.85 | Cancer Medication; Coverage for Orally and Intravenously Administered Treatments.

Section 3923.851 | Prior Authorization Requirements or Other Utilization Review Measures as Conditions of Providing Coverage of an Opioid Analgesic Prescribed for Treatment of Chronic Pain; Exceptions.

Section 3923.86 | Statement Provided to Insureds Under Vision Policy.

Section 3923.87 | Compliance With Section 3959.20.

Section 3923.89 | Payment or Reimbursement to Pharmacist.

Section 3923.90 | Teledentistry to Be Included in Coverage.

Section 3923.99 | Penalty.