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Ohio - Compensation & Benefit Legislation

OHIO - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

OHIO - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

Preventive care for children: Yes, to age 9.

(Ohio Rev. Code Ann. Sections 3923.24, 3923.26, 39.23.40, 3923.55)

OHIO - ALCOHOLISM & DRUG ABUSE

Mandatory coverage (alcoholism treatment only).

Minimum Yearly Inpatient Coverage: $550 for inpatient and outpatient combined.

Minimum Yearly Outpatient Coverage: $550 for inpatient and outpatient combined.

Minimum lifetime coverage: No statutory requirements.

(Ohio Rev. Code Ann. Section 3923.29).

OHIO - CAFETERIA PLAN TAX LAWS

OHIO - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

• Death: Yes, but insurer may offer conversion package in lieu of continuation of coverage.

• Job Termination: Yes, unless terminated for gross job misconduct. (To be eligible, employee must 6 months of continuous coverage prior to termination.)

• Reduction of Hours: No, unless reduction of hours terminates membership in the group.

• Divorce or Legal Separation: No, but insurer must offer conversion policy.

• Medicare Eligibility: No.

• Other Provisions: Termination of coverage for any other reason

• Early Termination of Continuation of Coverage: Becoming eligible for Medicare; becoming eligible for similar benefits, including coverage for pre-existing conditions under another group policy; failure to make a timely payment. (Ohio Rev. Code Ann. Sections 3923.32, 3923.38, 3923.381).

OHIO - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (Ohio Rev. Code Ann. Section 3902.13)

OHIO - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

OHIO - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

State has no statutory requirements.

OHIO - GROUP HEALTH CODE ADDITIONS (MANDATED)

Adopted Children: Group accident and sickness policies providing family coverage must cover adopted children from the date of placement with the insured. (Ohio Rev. Code Ann. Section 3923.40.)

Alcoholism Treatment: Group accident and sickness insurance policies must cover at least $550 annually in outpatient, inpatient, or intermediate primary care costs. (Ohio Rev. Code Ann. Section 3923.29.)

Continuation and Conversion: Group accident and sickness policies must provide continuation rights to employees terminating employment for themselves and their dependents. (Ohio Rev. Code Ann. Section 3923.) Individual policies must provide continuation rights to dependents ceasing to be eligible due to death of the insured, or dissolution of marriage. (Ohio Rev. Code Ann. Section 3923.32.) Group accident and sickness policies must provide conversion rights to employees terminating employment or membership in the group and to dependents who cease to be eligible due to age, death of the insured or dissolution of marriage. (Ohio Rev. Code Ann. Section 3924.25.)

Dialysis: Policies that cover costs of kidney dialysis must cover outpatient dialysis. (Ohio Rev. Code Ann. Section 3924..25.)

Handicapped Dependents: Coverage for dependent children cannot be terminated while a person is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (Ohio Rev. Code Ann. Section 3923.24.) Tax supported Institutions: Policies covering hospitalization costs for mental illness must cover costs of care provided by tax supported institutions. (Ohio Rev. Code Ann. Section 3923.27.)

Mammography Screening: Every individual or group health maintenance organization policy shall provide benefits for mammography and cytologic screening as follows: one mammography screening for women 35 to 40 years of age, one mammography screening every two years for women 40 to 50 years of age unless otherwise recommended by her physician, and one mammography screening every year for women 50 to 65 years of age. (Ohio Rev. Code Ann. Section 1742.40(B), ( C).)

Maternity: Health care policies, including HMOs, which provide maternity benefits must cover inpatient hospital care for a mother and her newborn baby for a minimum of 48 hours following a vaginal birth; inpatient hospital care must be covered for a mother and her newborn baby for a minimum of 96 hours following a Caesarean section. Decisions on allowing a hospital stay of a shorter duration for maternal delivery may be made by the attending physician or mid-wife after conferring with the mother. In cases of early discharges, medically necessary follow-up care must be provided by the health care professionals responsible for the discharge within 48 hours of discharge. No policy may terminate the participation of a health care facility as provider solely for making recommendations for inpatient or follow-up care in compliance with the law. Monetary or other financial incentives to encourage a mother to decline inpatient or follow-up care are prohibited. (H199, 1996.) (Ohio Rev. Code Ann. Section 1742.45, 3923.63, 5111.018.)

Mental Health: Group sickness and accident policies providing coverage for mental or emotional disorders must cover at least $550 annually of costs or providing such treatment on an outpatient basis. (Ohio Rev. Code Ann. Section 3923.28.)

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury or sickness including treatment of medically diagnosed congenital defects and birth abnormalities. (Ohio Rev. Code Ann. Section 39.23.26.)

Prescription Drugs: Group health care providers, including HMOs that provide prescription drug benefits, must not limit or exclude coverage of any drug approved by the FDA on the basis that the drug has not been approved by the agency for treatment of the particular indication for which the medication was prescribed. A medication must be recognized as safe and effective for treatment of a particular indication in one or more of the standard medical references for coverage to occur. Also, medically necessary services associated with the administration of these drugs must be covered. Coverage, however, must not be provided for drugs when have been determined by the FDA to have contraindications for the treatment of a particular indication for which the medication was prescribed; experimental drugs not approved for any indication by the FDA; and drugs not included in the drug formulary or list of covered drugs specified in a provider contract. (S107, 1995). (Ohio Rev. Code Ann. Section 1738.30.)

Providers: Osteopaths, optometrists, chiropractors, podiatrists, psychologists, dentists, mechanotherapists, nurse midwives under physician direction: Costs for services must be covered if the provider is licensed, the service with within the provider's scope of services, and the service is covered by the policy. (Ohio Rev. Code Ann. Sections 3923.23 - .234.)

OHIO - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

• Eligibility Criteria: 2 - 25 employees; majority must be employed within the state.

• Restrictions on premiums: Yes.

• Restrictions on cancellation: Yes.

• Pre-existing Conditions: No longer than 12 months after effective date of plan.

• Other: Basic Coverage as provided under a small employer health plan adopted by the board of directors of the small employer health re-insurance plan. (Ohio Rev. code Ann. Sections 3924.01, 3924.03, 3924.04, 3924.10)

OHIO - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes.

Percent of employees who must elect coverage (if employees pay part of premium): 75%.

Percent of employees who must be covered if employer pays all of premium: No statutory requirements.

Minimum number of employees in group plan: 10.

Employer prohibited as beneficiary: Yes.

Grace period (days): 31.

Mandatory conversion: Yes.

Other provisions: Insurer may not limit benefits if insured develops AIDS or tests HIV positive after effective date of policy.

(Ohio Rev. Code Ann. Sections 3901.45, 3917.01, 3917.06)

OHIO - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Thanksgiving. Other: Any day appointed by President or Governor. If any holiday falls on Sunday, following Monday is a holiday. (Ohio Rev. Code Ann. Sections 1.14, 5.20 through 5.30)

OHIO - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

OHIO - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

Remedies and Penalties: Violator is in contempt of court. Employee may bring civil action within 90 days of discharge for damages, reinstatement, and reasonable attorney fees. Damages not to exceed 6 weeks' wages.

Other Requirements: Employee must give employer prior notice of jury service. Public employee entitled to paid leave. (Ohio Rev. Code Ann. Sections 124.135, 2313.18.)

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: Yes, if served with subpoena.

Remedies and Penalties: Violator is in contempt of court.

Other Requirements: Public employee entitled to paid leave if he/she is not a party to the action.

OHIO - LEAVES OF ABSENCE

State reports no statutory requirements.

See U.S. Federal Family and Medical Leave Act

OHIO - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

OHIO - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, and midwives. Mandatory coverage for osteopaths and mechanotherapists. (Ohio Rev. Code Ann. Sections 3923.23, 3923.23.1, 3923.23.2, 3923.23.3, 3923.23.4)

OHIO - MENTAL HEALTH CARE

State reports no statutory requirements.

OHIO - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

Exemptions: Certain professionals, agriculture workers, domestics (other than housekeepers), outside sales, and students (sub-minimum wage of 85% of minimum wage in some cases). Apprentices (sub-minimum wage of 85%) and handicapped workers in special environments may be exempt by special license. (Ohio Rev. Code Ann. Sections 4111.01, 4111.02, 4111.06, 4111.07)

See U.S. Minimum Wage

OHIO - NEW HIRE REPORTING

Who is required to report: All employers.

Who must be reported: All new employees and rehires.

Exempt from reporting: No exemptions.

Form(s) to file: State form, W-4 form, or other mutually agreeable method.

Filing deadline: Within 20 days of hire.

Employer information to be included: Name, address, and EIN.

Employee information to be included: Name, address, and SSN.

Penalty for failure to report: Fines of $25 per employee may be imposed for an unintentional failure to report. A fine of $500 may be imposed for an intentional failure to report.

(Ohio Rev. Code Ann. Section 5101.312)

OHIO - NEWBORN CARE MANDATE

Mandated coverage.

Preventive care for children: Yes, to age 9. (Ohio Rev. Code Ann. Sections 3923.24, 3923.26, 39.23.40, 3923.55)

OHIO - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

OHIO - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, pre-existing condition provision shall not exclude or limit coverage beyond 12 months following the initial effective date. (Ohio Rev. Code Ann. Sections 3924.01, 3924.02, 3924.03, 3924.04, 3924.10)

See U.S. Federal Health Insurance Portability & Accountability Act

OHIO - PROTECTED CLASSIFICATIONS

Age: Yes.

Race: Yes.

Color: Yes.

National Origin: Yes.

Ancestry: Yes.

Religion: Yes.

Sex: Yes.

Pregnancy: Yes.

Sexual Harassment: Yes.

(Ohio Rev. Code Ann. Sections 4112.01, 4112.02; Ohio Admin. Code Sections 4112.5-02, 4112-5-05; Collins v. Rizkana, 652 N.E.2d 653 (Ohio 1995).

OHIO - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

OHIO - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

OHIO - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Under the general wage payment statute, the 1st of the month for wages earned up to 15th of preceding month; 15th of the month, for wages earned in second half of preceding month.

Date due if employee resigns: Under the general wage payment statute, the 1st of the month for wages earned up to 15th of preceding month; 15th of the month, for wages earned in second half of preceding month.

Wages: Yes. (Includes commissions.)

Vacation Pay: Yes.

Holiday: Yes.

Sick leave: Yes.

Severance: Yes.

(Ohio Rev. Code Ann. Sections 4111.01, 4113.15)

OHIO - UNEMPLOYMENT TAX

Employer Contributions:

• Tax Rate (%):      

• Standard: 3.0

• Maximum: 6.5

• Minimum: 0.1

Voluntary Contribution Provision: Yes. By December 31.

(Ohio Rev. Code Ann. Sections 4141.01, 4141.18, 4141.24. 4141.25.)

OHIO - VACATION PAY

See TERMINATION & SEVERANCE PAY (above)

OHIO - VOTING TIME OFF

A reasonable amount of time to vote. (Ohio Rev. Code Ann. Sections 3599.05, 3599.06.)

OHIO - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments. Elective as to partners and sole proprietors.

Public Employers: Mandatory coverage to state, counties, cities, townships, incorporated villages, and school districts.

Exceptions: Casual and domestic workers paid less that $160 by 1 employer in any 3 month period.

Special Coverage Provisions: Elective as to officers of family farm corporations and for ordained and licensed ministers in the exercise of their ministry.

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)