Effective: September 18, 1997
Latest Legislation: Senate Bill 130 - 122nd General Assembly
(A) As used in this section:
(1) "Eligible person" means any person who, at the time a reservist is called or ordered to active duty, is covered under a group policy and is either of the following:
(a) An employee who is a reservist called or ordered to active duty;
(b) The spouse or a dependent child of an employee described in division (A)(1)(a) of this section.
(2) "Group policy" includes any group sickness and accident insurance policy that satisfies all of the following:
(a) The policy is delivered, issued for delivery, or renewed in this state on or after April 17, 1991.
(b) The policy covers employees for hospital, surgical, or major medical insurance on an expense incurred or service basis, other than for specified diseases or accidental injuries only.
(c) The policy is in effect and covers an eligible person at the time a reservist is called or ordered to active duty.
(3) "Reservist" means a member of a reserve component of the armed forces of the United States. "Reservist" includes a member of the Ohio national guard.
(B) Every group policy shall provide that any eligible person may continue the coverage under the policy for a period of eighteen months after the date on which the coverage would otherwise terminate because the reservist is called or ordered to active duty.
(C)(1) An eligible person may extend the eighteen-month period of continuation of coverage to a thirty-six-month period of continuation of coverage, if any of the following occurs during the eighteen-month period:
(a) The death of the reservist;
(b) The divorce or separation of a reservist from the reservist's spouse;
(c) The cessation of dependency of a child pursuant to the terms of the policy.
(2) The thirty-six-month period of continuation of coverage is deemed to begin on the date on which the coverage would otherwise terminate because the reservist is called or ordered to active duty.
(3) The employer may begin the thirty-six-month period on the date of any occurrence described in division (C)(1) of this section.
(D) All of the following apply to any continuation of coverage, or the extension of any continuation of coverage, provided under division (B) or (C) of this section:
(1) The continuation of coverage shall provide the same benefits as those provided to any similarly situated eligible person who is covered under the same group policy and an employee who has not been called or ordered to active duty.
(2) An employer shall notify each employee of the right of continuation of coverage at the time of employment. At the time the reservist is called or ordered to active duty, the employer shall notify each eligible person of the requirements for the continuation of coverage.
(3) Each certificate of coverage issued by an insurer to an employee under the group policy shall include a notice of the eligible person's right of continuation of coverage.
(4) An eligible person shall file a written election of continuation of coverage with the employer and pay the employer the first contribution required under division (D)(5) of this section. The written election and payment must be received by the employer no later than thirty-one days after the date on which the eligible person's coverage would otherwise terminate. If the employer notifies the eligible person of the right of continuation of coverage after the date on which the eligible person's coverage would otherwise terminate, the written election and payment must be received by the employer no later than thirty-one days after the date of the notification.
(5)(a) Except as provided in division (D)(5)(b) or (c) of this section, the eligible person shall pay to the employer, on a monthly basis and in advance, the amount of contribution required by the employer. The amount shall not exceed one hundred two per cent of the group rate for the coverage being continued under the group policy on the due date of each payment.
(b) The employer may pay a portion or all of the eligible person's contribution.
(c) A reservist called or ordered to active duty for less than thirty-one days shall not be required to pay more than the eligible person's contribution, if any, for the coverage.
(E) The eligible person's right to any continuation of coverage, or the extension of any continuation of coverage, provided under division (B) or (C) of this section ceases on the date on which any of the following occurs:
(1) The eligible person, whether as an employee or otherwise, enrolls in another group policy or other group health plan or arrangement that does not contain any exclusion or limitation with respect to any preexisting condition of that eligible person. For purposes of division (E)(1) of this section, a group policy or other group health plan or arrangement does not include the civilian health and medical program of the uniformed services as defined in Public Law 99-661, 100 Stat. 3898 (1986), 10 U.S.C.A. 1072.
(2) The period of either eighteen months provided under division (B) of this section or thirty-six months provided under division (C) of this section expires.
(3) The eligible person fails to make a timely payment of a required contribution, in which case the coverage ceases at the end of the period of coverage for which contributions were made.
(4) The group policy, or participation under the group policy, is terminated, unless the employer, in accordance with division (F) of this section, replaces the coverage with similar coverage under another group policy or other group health plan or arrangement.
(F) If the employer replaces the group policy with similar coverage as described in division (E)(4) of this section, both of the following apply:
(1) The eligible person is covered under the replacement coverage for the balance of the period that the eligible person would have remained covered under the terminated coverage if it had not been terminated.
(2) The level of benefits under the replacement coverage is the same as the level of benefits provided to any similarly situated eligible person who is covered under the group policy and an employee who has not been called or ordered to active duty.
(G) Upon the reservist's release from active duty and return to employment for the employer by whom the reservist was employed at the time of being called or ordered to active duty, both of the following apply:
(1) Every eligible person is entitled, without any waiting period, to coverage under the employer's group policy that is in effect at the time of the reservist's return to employment.
(2) Every eligible person is entitled to all benefits under the group policy described in division (G)(1) of this section from the date of the original coverage under the policy.
(H)(1) No insurer shall fail to provide for a continuation of coverage, or an extension of a continuation of coverage, in a group policy as required by and in accordance with the terms and conditions set forth under this section.
(2) No insurer shall fail to issue a certificate of coverage in compliance with division (D)(3) of this section.
(3) No employer shall fail to provide an employee or eligible person with notice of the right to a continuation of coverage under a group policy in accordance with division (D)(2) of this section.
(I) Whoever violates division (H)(1), (2), or (3) of this section is deemed to have engaged in an unfair and deceptive act or practice in the business of insurance under sections 3901.19 to 3901.26 of the Revised Code.
Structure Ohio Revised Code
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 3923.13 | 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 3923.17 | 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 3923.231 | Reimbursement for Services of Licensed Psychologist.
Section 3923.232 | Reimbursement for Services of Licensed Dentist.
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 3923.31 | Right to Rescind Individual Policy of Sickness and Accident Insurance.
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 3923.338 | Orders of Superintendent.
Section 3923.339 | Severability.
Section 3923.36 | Excluding Coverage of Illness or Injury Covered by Workers' Compensation.
Section 3923.38 | Continuing Policy Upon Termination of Employment.
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 3923.441 | 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 3923.46 | Rates for Individual Policy.
Section 3923.48 | Violation Is Unfair and Deceptive Insurance Practice.
Section 3923.49 | Establishing Outreach Program to Educate Consumers.
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 3923.57 | Pre-Existing Conditions Provisions.
Section 3923.60 | Standard Medical Reference Compendia for Coverage of Prescription Drugs.
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 3923.84 | Coverage for Autism Spectrum Disorder.
Section 3923.85 | Cancer Medication; Coverage for Orally and Intravenously Administered Treatments.
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.