State RegulationsOH specificDifficulty 3/5
A Cleveland insurer proposes a renewal rate for one small employer driven almost entirely by a single employee's expensive medical claims. Under ORC 3924.04 and Ohio's rating limits for small employers:
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
ORC 3924.04 confines small-employer rate variation to Ohio's rating limits, and those limits are designed to stop an individual employee's health status or claims from determining what a small employer pays. A renewal increase keyed to one person's medical costs falls outside the lawful rating framework, protecting small groups from being priced out because one employee gets sick.
Why the other options are wrong
- A) Unrestricted use of individual claims experience is exactly what the ORC 3924.04 rating limits forbid.
- C) Employee consent cannot cure a rating method that Ohio law does not allow.
- D) Ohio's own rating limits in ORC 3924.04 govern small-employer rates here; the field is not exclusively federal.
Memory hook
One sick employee can't price the whole small group out — Ohio's rating limits say so.