State RegulationsOH specificDifficulty 2/5
An agent is asked which kinds of Ohio health coverage are subject to the state's prior-authorization statutes. Which answer is correct?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Ohio's prior-authorization framework reaches both product families: ORC 3923.041 governs utilization-review and prior-authorization procedures in accident and sickness policies, while ORC 1751.72 imposes the parallel duty on health insuring corporation contracts. A producer should therefore expect advance-approval procedures in both traditional A&H coverage and HIC plans.
Why the other options are wrong
- B) ORC 3923.041 applies prior-authorization requirements to A&H policies, so they are not exempt.
- C) Medicare supplement marketing and free-look rules are separate provisions; the prior-authorization statutes are ORC 3923.041 and 1751.72.
- D) Group life riders are not the subject of the prior-authorization statutes; they address A&H policies and HIC contracts.
Memory hook
Two statutes, two products: A&H and HIC — both need the prior OK.