Ohio Code 3959.14 – Administrator prohibitions
No administrator shall do any of the following:
Terms Used In Ohio Code 3959.14
- Administrator: includes a pharmacy benefit manager. See Ohio Code 3959.01
- Aggregate excess insurance: means that type of coverage whereby the insurer agrees to reimburse the insured employer or trust for all benefits or claims paid during an agreement period on behalf of all covered persons under the plan or trust which exceed a stated deductible amount and subject to a stated maximum. See Ohio Code 3959.01
- Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
- in writing: includes any representation of words, letters, symbols, or figures; this provision does not affect any law relating to signatures. See Ohio Code 1.59
- Plan: means any arrangement in written form for the payment of life, dental, health, or disability benefits to covered persons defined by the summary plan description and includes a drug benefit plan administered by a pharmacy benefit manager. See Ohio Code 3959.01
- Plan sponsor: means the person who establishes the plan. See Ohio Code 3959.01
- Specific excess insurance: means that type of coverage whereby the insurer agrees to reimburse the insured employer or trust for all benefits or claims paid during an agreement period on behalf of a covered person in excess of a stated deductible amount and subject to a stated maximum. See Ohio Code 3959.01
(A) Use plan sponsor funds for any purpose or purposes not specifically set forth in written form by the administrator;
(B) Fail to disclose in written solicitation material and on an on-going basis, at least once annually, to the plan sponsor all of the following:
(1) All fixed plan costs, identifying what each fixed cost includes;
(2) Levels of the specific excess insurance stop-loss deductible;
(3) The aggregate excess insurance stop-loss attachment point factors, including any minimum attachment point factors;
(4) The names of all insurance carriers providing protection for the plan sponsor’s plans, and any ownership relationship of five per cent or more between the administrator and such insurance carriers.
(C) Fail to remit insurance company premiums within the policy period or within the time period agreed to in writing between the insurance company and the administrator;
(D) Fail to disclose in written form the method of collecting and holding any plan sponsor’s funds.