3956.04 Application of chapter.
3956.04 Application of chapter.
(A) This chapter provides coverage, by the Ohio life and health insurance guaranty association, for the policies and contracts specified in division (B) of this section to all of the following persons:
(1) Persons who are the beneficiaries, assignees, or payees of the persons covered under division (A)(2) of this section, regardless of where they reside, except for nonresident certificate holders under group policies or contracts;
(2) Persons who are owners of or certificate holders under the policies or contracts, or, in the case of unallocated annuity contracts, the persons who are the contract holders, if either of the following applies:
(a) The persons are residents of this state;
(b) The persons are not residents of this state and all of the following conditions apply:
(i) The insurers that issued the policies or contracts are domiciled in this state;
(ii) At the time the policies or contracts were issued, the insurers did not hold a license or certificate of authority in the states in which the persons reside;
(iii) The states have associations similar to the association created by section 3956.06 of the Revised Code;
(iv) The persons are not eligible for coverage by those associations.
(B)(1) This chapter provides coverage to the persons specified in division (A) of this section for direct, nongroup life, health, annuity, and supplemental policies or contracts, for certificates under direct group policies and contracts, and for unallocated annuity contracts issued by member insurers, except as otherwise limited in this chapter. Annuity contracts and certificates under group annuity contracts include, but are not limited to, guaranteed investment contracts, deposit administration contracts, unallocated funding agreements, allocated funding agreements, structured settlement agreements, lottery contracts, and any immediate or deferred annuity contracts.
(2) This chapter does not provide coverage for any of the following:
(a) Any portion of a policy or contract not guaranteed by the insurer, or under which the risk is borne by the policy or contract holder;
(b) Any policy or contract of reinsurance, unless assumption certificates have been issued;
(c) Any portion of a policy or contract to the extent that the rate of interest on which it is based:
(i) Averaged over the period of four years prior to the date on which the association becomes obligated with respect to the policy or contract or if the policy or contract has been issued for a lesser period averaged over that period, exceeds the rate of interest determined by subtracting two percentage points from the monthly average-corporates as published by Moody’s investors service, inc., or any successor to that service, averaged for the same period;
(ii) On and after the date on which the association becomes obligated with respect to the policy or contract, exceeds the rate of interest determined by subtracting three percentage points from the monthly average-corporates as published by Moody’s investors service, inc., or any successor to that service, as most recently available.
If the monthly average-corporates is no longer published, the superintendent, by rule, shall establish a substantially similar average.
(d) Any plan or program of an employer, association, or similar entity to provide life, health, or annuity benefits to its employees or members to the extent that the plan or program is self-funded or uninsured, including but not limited to benefits payable by an employer, association, or similar entity under any of the following:
(i) A multiple employer welfare arrangement as defined in section 514 of the “Employee Retirement Income Security Act of 1974,” 88 Stat. 833, 29 U.S.C.A. 1001, as amended;
(ii) A minimum premium group insurance plan;
(iii) A stop-loss group insurance plan;
(iv) An administrative services only contract.
(e) Any portion of a policy or contract to the extent that it provides dividends or experience rating credits, or provides that any fees or allowances be paid to any person, including the policy or contract holder, in connection with the service to or administration of the policy or contract;
(f) Any policy or contract issued in this state by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue the policy or contract in this state;
(g) Any unallocated annuity contract issued to an employee benefit plan protected under the federal pension benefit guaranty corporation;
(h) Any portion of any unallocated annuity contract that is not issued to or in connection with a governmental lottery or a benefit plan of a specific employee, union, or association of natural persons;
(i) Any policy or contract issued to or for the benefit of a past or present director or officer within one year of the filing of the successful complaint that the insurer was impaired or insolvent;
(j) Any policy or contract issued by any entity described in division (F)(2) of section 3956.01 of the Revised Code;
(k) Any policy or contract issued by a member insurer if the member insurer is carrying on as a line of business, and not as a separate legal entity, the activities of any entity described in division (F)(2) of section 3956.01 of the Revised Code, and the policy or contract is issued as a product of those activities.
(C) The benefits for which the association may become liable shall not exceed the lesser of either of the following:
(1) The contractual obligations for which the insurer is liable or would have been liable if it were not an impaired or insolvent insurer;
(2)(a) With respect to any one life, regardless of the number of policies or contracts:
(i) Three hundred thousand dollars in life insurance death benefits, but not more than one hundred thousand dollars in net cash surrender and net cash withdrawal values for life insurance;
(ii) One hundred thousand dollars in health insurance benefits, including any net cash surrender and net cash withdrawal values;
(iii) Two hundred fifty thousand dollars in the present value of annuity benefits, including net cash surrender and net cash withdrawal values.
(b) With respect to each individual participating in a governmental retirement plan established under section 401, 403(b), or 457 of the “Internal Revenue Code of 1986,” 100 Stat. 2085, 26 U.S.C.A. 1, as amended, and covered by an unallocated annuity contract, or the beneficiaries of each such individual if deceased, in the aggregate, two hundred fifty thousand dollars in present value annuity benefits, including net cash surrender and net cash withdrawal values.
The association is not liable to expend more than three hundred thousand dollars in the aggregate with respect to any one individual under divisions (C)(2)(a) and (b) of this section combined.
(c) With respect to any one contract holder, covered by any unallocated annuity contract not included in division (C)(2)(b) of this section, one million dollars in benefits, irrespective of the number of those contracts held by that contract holder.
(D) The liability of the association is limited strictly by the express terms of the policies or contracts and by this chapter, and is not affected by the contents of any brochures, illustrations, advertisements in the print or electronic media, or other advertising material used in connection with the sale of the policies or contracts, or by oral statements made by agents or other sales representatives in connection with the sale of the policies or contracts. The association is not liable for extra-contractual damages, punitive damages, attorney’s fees, or interest other than as provided for by the terms of the policies or contracts as limited by this chapter, that might be awarded by any court or governmental agency in connection with the policies or contracts.
(E) The protection provided by this chapter does not apply where any guaranty protection is provided to residents of this state by the laws of the domiciliary state or jurisdiction of the impaired or insolvent insurer other than this state.
Amended by 128th General Assembly File No. 18, HB 300, § 1, eff. 5/26/2010.
Effective Date: 11-20-1989
See 128th General Assembly File No. 18, HB 300, §3.