Ohio § 4123.29

§ 4123.29.

(A) The administrator of workers' compensation, subject to the approval of the bureau

of workers' compensation board of directors, shall do all of the following: (1) Classify occupations or industries with respect to their degree of hazard and determine

the risks of the different classes according to the categories the national council

on compensation insurance establishes that are applicable to employers in this state; (2)(a) Fix the rates of premium of the risks of the classes based upon the total payroll

in each of the classes of occupation or industry sufficiently large to provide a fund

for the compensation provided for in this chapter and to maintain a state insurance

fund from year to year.  The administrator shall set the rates at a level that assures the solvency of the

fund.  Where the payroll cannot be obtained or, in the opinion of the administrator, is

not an adequate measure for determining the premium to be paid for the degree of hazard,

the administrator may determine the rates of premium upon such other basis, consistent

with insurance principles, as is equitable in view of the degree of hazard, and whenever

in this chapter reference is made to payroll or expenditure of wages with reference

to fixing premiums, the reference shall be construed to have been made also to such

other basis for fixing the rates of premium as the administrator may determine under

this section. (b) If an employer elects to obtain other-states' coverage, including limited other-states'

coverage, pursuant to section 4123.292 of the Revised Code through the administrator, if the administrator elects to offer such coverage, calculate

the employer's premium for the state insurance fund in the same manner as otherwise

required under division (A) of this section and section 4123.34 of the Revised Code , except that the administrator may establish in rule an alternative calculation of

the employer's premium to appropriately account for the expenditure of wages, payroll,

or both attributable to the labor performed and services provided by that employer's

employees when those employees performed labor and provided services in this state

and in the other state or states for which the employer elects to secure other-states'

coverage. (c) If an employer elects to obtain other-states' coverage pursuant to section 4123.292 of the Revised Code through an other-states' insurer, calculate the employer's premium for the state

insurance fund in the same manner as otherwise required under division (A) of this

section and section 4123.34 of the Revised Code , except that when the administrator determines the expenditure of wages, payroll,

or both upon which to base the employer's premium, the administrator shall use only

the expenditure of wages, payroll, or both attributable to the labor performed and

services provided by that employer's employees when those employees performed labor

and provided services in this state only and to which the other-states' coverage does

not apply.  The administrator may adopt rules setting forth the information that an employer

electing to obtain other-states' coverage through an other-states' insurer shall report

for purposes of determining the expenditure of wages, payroll, or both attributable

to the labor performed and services provided in this state. (d) The administrator in setting or revising rates shall furnish to employers an adequate

explanation of the basis for the rates set. (3) Develop and make available to employers who are paying premiums to the state insurance

fund alternative premium plans.  Alternative premium plans shall include retrospective rating plans.  The administrator may make available plans under which an advanced deposit may be

applied against a specified deductible amount per claim. (4)(a) Offer to insure the obligations of employers under this chapter under a plan that

groups, for rating purposes, employers, and pools the risk of the employers within

the group provided that the employers meet all of the following conditions: (i) All of the employers within the group are members of an organization that has been

in existence for at least two years prior to the date of application for group coverage; (ii) The organization was formed for purposes other than that of obtaining group workers'

compensation under this division; (iii) The employers' business in the organization is substantially similar such that the

risks which are grouped are substantially homogeneous; (iv) The group of employers consists of at least one hundred members or the aggregate

workers' compensation premiums of the members, as determined by the administrator,

are estimated to exceed one hundred fifty thousand dollars during the coverage period; (v) The formation and operation of the group program in the organization will substantially

improve accident prevention and claims handling for the employers in the group; (vi) Each employer seeking to enroll in a group for workers' compensation coverage has

an account in good standing with the bureau of workers' compensation.  The administrator shall adopt rules setting forth the criteria by which the administrator

will determine whether an employer's account is in good standing. (b) If an organization sponsors more than one employer group to participate in group

plans established under this section, that organization may submit a single application

that supplies all of the information necessary for each group of employers that the

organization wishes to sponsor. (c) In providing employer group plans under division (A)(4) of this section, the administrator

shall consider an employer group as a single employing entity for purposes of group

rating.  No employer may be a member of more than one group for the purpose of obtaining

workers' compensation coverage under this division. (d) At the time the administrator revises premium rates pursuant to this section and section 4123.34 of the Revised Code , if the premium rate of an employer who participates in a group plan established

under this section changes from the rate established for the previous year, the administrator,

in addition to sending the invoice with the rate revision to that employer, shall

provide an explanation of the rate revision to the third-party administrator that

administers the group plan for that employer's group. (e) In providing employer group plans under division (A)(4) of this section, the administrator

shall establish a program designed to mitigate the impact of a significant claim that

would come into the experience of a private, state fund group-rated employer or a

taxing district employer for the first time and be a contributing factor in that employer

being excluded from a group-rated plan.  The administrator shall establish eligibility criteria and requirements that such

employers must satisfy in order to participate in this program.  For purposes of this program, the administrator shall establish a discount on premium

rates applicable to employers who qualify for the program. (f) In no event shall division (A)(4) of this section be construed as granting to an

employer status as a self-insuring employer. (g) The administrator shall develop classifications of occupations or industries that

are sufficiently distinct so as not to group employers in classifications that unfairly

represent the risks of employment with the employer. (5) Generally promote employer participation in the state insurance fund through the

regular dissemination of information to all classes of employers describing the advantages

and benefits of opting to make premium payments to the fund.  To that end, the administrator shall regularly make employers aware of the various

workers' compensation premium packages developed and offered pursuant to this section. (6) Make available to every employer who is paying premiums to the state insurance fund

a program whereby the employer or the employer's agent pays to the claimant or on

behalf of the claimant the first fifteen thousand dollars of a compensable workers'

compensation medical-only claim filed by that claimant that is related to the same

injury or occupational disease.  No formal application is required;  however, an employer must elect to participate

by telephoning the bureau after July 1, 1995.  Once an employer has elected to participate in the program, the employer will be

responsible for all bills in all medical-only claims with a date of injury the same

or later than the election date, unless the employer notifies the bureau within fourteen

days of receipt of the notification of a claim being filed that it does not wish to

pay the bills in that claim, or the employer notifies the bureau that the fifteen

thousand dollar maximum has been paid, or the employer notifies the bureau of the

last day of service on which it will be responsible for the bills in a particular

medical-only claim.  If an employer elects to enter the program, the administrator shall not reimburse

the employer for such amounts paid and shall not charge the first fifteen thousand

dollars of any medical-only claim paid by an employer to the employer's experience

or otherwise use it in merit rating or determining the risks of any employer for the

purpose of payment of premiums under this chapter.  A certified health care provider shall extend to an employer who participates in

this program the same rates for services rendered to an employee of that employer

as the provider bills the administrator for the same type of medical claim processed

by the bureau and shall not charge, assess, or otherwise attempt to collect from an

employee any amount for covered services or supplies that is in excess of that rate.  If an employer elects to enter the program and the employer fails to pay a bill

for a medical-only claim included in the program, the employer shall be liable for

that bill and the employee for whom the employer failed to pay the bill shall not

be liable for that bill.  The administrator shall adopt rules to implement and administer division (A)(6)

of this section.  Upon written request from the bureau, the employer shall provide documentation to

the bureau of all medical-only bills that they are paying directly.  Such requests from the bureau may not be made more frequently than on a semiannual

basis.  Failure to provide such documentation to the bureau within thirty days of receipt

of the request may result in the employer's forfeiture of participation in the program

for such injury.  The provisions of this section shall not apply to claims in which an employer with

knowledge of a claimed compensable injury or occupational disease, has paid wages

in lieu of compensation or total disability. (B) The administrator, with the advice and consent of the board, by rule, may do both

of the following: (1) Grant an employer who pays the employer's annual estimated premium in full prior

to the start of the policy year for which the estimated premium is due, a discount

as the administrator fixes from time to time; (2) Levy a minimum annual administrative charge upon risks where premium reports develop

a charge less than the administrator considers adequate to offset administrative costs

of processing.