State RegulationsOH specificDifficulty 2/5
A Toledo machine shop applies for small-employer health coverage. Several employees have significant medical conditions, and the carrier prefers not to write the account. Under ORC 3924.03, the carrier:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
ORC 3924.03's guaranteed-issue rule answers this directly: an eligible small employer that applies cannot be refused coverage because of the health status or claims experience of its employees. Carriers price within the rating limits of ORC 3924.04, but they cannot use underwriting to keep a medically unfavorable small group out of the market.
Why the other options are wrong
- A) Declining for claims history is exactly what the guaranteed-issue rule in ORC 3924.03 forbids.
- B) Carving out the sick employees is not an option; the rule protects the eligible small employer as a whole.
- D) There is no subsidy-referral mechanism in ORC 3924.03; the carrier's duty is to offer coverage to the eligible small employer.
Memory hook
Guaranteed issue says yes to the group — health status can't be the reason to say no.