State RegulationsOH specificDifficulty 2/5
An Ohio issuer is designing the benefit package for a new Medicare supplement policy. Which provision would violate Ohio law?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
ORC 3923.332(A) prohibits any Medicare supplement policy or certificate from containing benefits that duplicate Medicare benefits. Paying what Medicare already pays is duplication and is unlawful, whether the design appears in the core package or as an add-on. By contrast, benefits directed at Medicare's gaps — cost-sharing amounts and services Medicare leaves uncovered — are exactly what the product is for, and OAC 3901-8-08 frames the Ohio review of these product designs.
Why the other options are wrong
- B) Covering cost-sharing amounts such as deductibles and coinsurance is the legitimate gap-filling purpose of the product.
- C) Paying for services Medicare does not cover supplements rather than duplicates Medicare and is permitted.
- D) Supplementing hospital benefits is lawful; only duplication of Medicare payments is barred.
Memory hook
Design the benefit around Medicare's gaps, never on top of Medicare's checks.