State RegulationsOH specificDifficulty 2/5
A member of a Toledo health insuring corporation complains that she cannot tell from her documents which services are covered and which are excluded. Under Ohio law governing evidence-of-coverage documents, the document must:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The evidence-of-coverage requirements under ORC 1751.11 and ORC 1751.33 are designed so that members can see what their health insuring corporation coverage provides. The document must present both the benefits and the exclusions clearly, because a member who cannot identify exclusions cannot understand the limits of the coverage.
Why the other options are wrong
- B) Wrong: the coverage document presents both benefits and exclusions; benefits are not left entirely to general law.
- C) Wrong: general descriptions that hide material details defeat the disclosure purpose of ORC 1751.11 and ORC 1751.33.
- D) Wrong: disclosure is not on-demand; the document must present benefits and exclusions as part of the coverage description.
Memory hook
Benefits plus exclusions, both on the page.