Ohio Life & Health Study Guide

Ohio tracks the NAIC pattern here, which is exactly why candidates lose marks — the shape is familiar enough that nobody reads the detail. Organise the chapter around the two places it bites: guaranty caps all measured the same way and all living in one subsection, and a free-look right that belongs to the product rather than to any general rule.

The guaranty caps — one subsection, one measurement

The safety net is the Ohio Life and Health Insurance Guaranty Association (OLHIGA), created under ORC Chapter 3956, and every dollar figure in it sits in ORC 3956.04(D):

• $300,000 in life death benefits — (D)(2)(a)(i)
• $100,000 in net cash surrender and net cash withdrawal values for life insurance — a sub-limit inside the $300,000, not a separate bucket, and also at (a)(i)
• $100,000 for health coverage that is not a health benefit plan, disability income or long-term care — (a)(ii)
• $300,000 for disability income — (a)(iii)
• $300,000 for long-term care — (a)(iv)
• $500,000 for “health benefit plan coverage” — (a)(v)
• $250,000 in the present value of annuity benefits, including net cash surrender and withdrawal values — (a)(vi)
• $250,000 for a governmental retirement plan participant, and $250,000 for a structured settlement annuity
• $5,000,000 per contract holder for an unallocated annuity — (D)(2)(c)

Learn $500,000 for health benefit plan coverage in the statute’s own phrase; a stem offering “basic hospital, medical or major medical” is offering someone else’s vocabulary. The $5,000,000 unallocated annuity figure is the other to over-learn, because summaries omit it.

The measurement rule covers all of them: every cap is the lesser of the insurer’s contractual obligation under (D)(1) or the scheduled amount under (D)(2).

The aggregate — and the ceiling that is not there

The per-individual aggregate is $300,000 across all coverages, rising to $500,000 where health benefit plan coverage is involved — two aggregates, not one.

Where it lives is the exam’s favourite trick. It sits in an unlettered flush paragraph inside (D)(2), between (b) and (c), with no subsection letter of its own, which is why candidates cite the wrong division or miss it entirely. Its reach follows its position: it applies across (a), (b) and (d), but not across the unallocated annuity cap at (c).

And note what this association does not have: a net-worth exclusion. There is none on the life and health side at all — the $50,000,000 net-worth test belongs to the property and casualty association under Chapter 3955.

The free-look matrix

Ask for Ohio’s free look and you get a number; ask on what and the answer falls apart, because Ohio attaches the right to products:

• Ordinary, non-replacement individual life — none. The ten days in the life disclosure rule are a condition on Buyer’s Guide delivery timing, not a right to return the policy.
• Any life policy or annuity issued in a replacement transaction — 30 days from delivery, for an unconditional full refund of all premiums, including policy fees and charges (OAC 3901-6-05(G)(1)(d)).
• Variable life — 10 days from receipt of the policy (OAC 3901-6-08(E)(3)(a)(v)).
• Individual sickness and accident — 10 days. Returnable until midnight of the tenth day after receipt, no reason stated; only a strictly per diem pro rata premium may be retained; the notice must be printed prominently on the first page; single-premium nonrenewable policies are excluded (ORC 3923.31(A)(1), (A)(2), (C), (D)).
• Long-term care — 30 days from delivery, using 3923.31’s procedures (ORC 3923.44).
• Annuity outside a replacement — 15 days, conditionally. OAC 3901-6-14(E)(4) creates it only where the Buyer’s Guide and the disclosure document were not delivered at or before application, and it runs concurrently with any other free look.

That last one is really a rule about your conduct. Deliver both documents on time and no fifteen-day right arises; deliver them late and you have created one.

You may not sell with the safety net

ORC 3956.18 closes the loop. Using the association’s existence as a sales inducement is prohibited — no advertising it, no working it into a solicitation, no using it to close. The obligation is not only negative: under (A)(1), (B) and (C) the member insurer must deliver a Superintendent-approved summary document with a clear and conspicuous disclaimer naming the association, warning of its substantial limitations and exclusions, and stating that agents may not use it to sell insurance.