Ohio § 3923.57

§ 3923.57.

Notwithstanding any provision of this chapter, every individual policy of sickness

and accident insurance that is delivered, issued for delivery, or renewed in this

state is subject to the following conditions, as applicable: (A) Pre-existing conditions provisions shall not exclude or limit coverage for a period

beyond twelve months following the policyholder's effective date of coverage and may

only relate to conditions during the six months immediately preceding the effective

date of coverage. (B) In determining whether a pre-existing conditions provision applies to a policyholder

or dependent, each policy shall credit the time the policyholder or dependent was

covered under a previous policy, contract, or plan if the previous coverage was continuous

to a date not more than thirty days prior to the effective date of the new coverage,

exclusive of any applicable service waiting period under the policy. (C)(1) Except as otherwise provided in division (C) of this section, an insurer that provides

an individual sickness and accident insurance policy to an individual shall renew

or continue in force such coverage at the option of the individual. (2) An insurer may nonrenew or discontinue coverage of an individual in the individual

market based only on one or more of the following reasons: (a) The individual failed to pay premiums or contributions in accordance with the terms

of the policy or the insurer has not received timely premium payments. (b) The individual performed an act or practice that constitutes fraud or made an intentional

misrepresentation of material fact under the terms of the policy. (c) The insurer is ceasing to offer coverage in the individual market in accordance with

division (D) of this section and the applicable laws of this state. (d) If the insurer offers coverage in the market through a network plan, the individual

no longer resides, lives, or works in the service area, or in an area for which the

insurer is authorized to do business;  provided, however, that such coverage is terminated

uniformly without regard to any health status-related factor of covered individuals. (e) If the coverage is made available in the individual market only through one or more

bona fide associations, the membership of the individual in the association, on the

basis of which the coverage is provided, ceases;  provided, however, that such coverage

is terminated under division (C)(2)(e) of this section uniformly without regard to

any health status-related factor of covered individuals. (3) An insurer may cancel or decide not to renew the coverage of a dependent of an individual

if the dependent has performed an act or practice that constitutes fraud or made an

intentional misrepresentation of material fact under the terms of the coverage and

if the cancellation or nonrenewal is not based, either directly or indirectly, on

any health status-related factor in relation to the dependent. (D)(1) If an insurer decides to discontinue offering a particular type of health insurance

coverage offered in the individual market, coverage of such type may be discontinued

by the insurer if the insurer does all of the following: (a) Provides notice to each individual provided coverage of this type in such market

of the discontinuation at least ninety days prior to the date of the discontinuation

of the coverage; (b) Offers to each individual provided coverage of this type in such market, the option

to purchase any other individual health insurance coverage currently being offered

by the insurer for individuals in that market; (c) In exercising the option to discontinue coverage of this type and in offering the

option of coverage under division (D)(1)(b) of this section, acts uniformly without

regard to any health status-related factor of covered individuals or of individuals

who may become eligible for such coverage. (2) If an insurer elects to discontinue offering all health insurance coverage in the

individual market in this state, health insurance coverage may be discontinued by

the insurer only if both of the following apply: (a) The insurer provides notice to the department of insurance and to each individual

of the discontinuation at least one hundred eighty days prior to the date of the expiration

of the coverage. (b) All health insurance delivered or issued for delivery in this state in such market

is discontinued and coverage under that health insurance in that market is not renewed. (3) In the event of a discontinuation under division (D)(2) of this section in the individual

market, the insurer shall not provide for the issuance of any health insurance coverage

in the market and this state during the five-year period beginning on the date of

the discontinuation of the last health insurance coverage not so renewed. (E) Notwithstanding divisions (C) and (D) of this section, an insurer may, at the time

of coverage renewal, modify the health insurance coverage for a policy form offered

to individuals in the individual market if the modification is consistent with the

law of this state and effective on a uniform basis among all individuals with that

policy form. (F) Such policies are subject to sections 2743 and 2747 of the “Health Insurance Portability

and Accountability Act of 1996,” Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg-43 and 300gg-47 , as amended. (G) Sections 3924.031 and 3924.032 of the Revised Code shall apply to sickness and accident insurance policies offered in the individual

market in the same manner as they apply to health benefit plans offered in the small

employer market. In accordance with 45 C.F.R. 148.102 , divisions (C) to (G) of this section also apply to all group sickness and accident

insurance policies that are not sold in connection with an employment-related group

health plan and that provide more than short-term, limited duration coverage. In applying divisions (C) to (G) of this section with respect to health insurance

coverage that is made available by an insurer in the individual market to individuals

only through one or more associations, the term “ individual ” includes the association of which the individual is a member. For purposes of this section, any policy issued pursuant to division (C) of section 3923.13 of the Revised Code in connection with a public or private college or university student health insurance

program is considered to be issued to a bona fide association. As used in this section, “bona fide association” has the same meaning as in section 3924.03 of the Revised Code , and “health status-related factor” and “network plan” have the same meanings as

in section 3924.031 of the Revised Code . This section does not apply to any policy that provides coverage for specific diseases

or accidents only, or to any hospital indemnity, medicare supplement, long-term care,

disability income, one-time-limited-duration policy that is less than twelve months,

or other policy that offers only supplemental benefits.