Current through all regulations passed and filed through September 16, 2024
(A) Sponsoring organization requirements.
(1) A sponsoring organization shall make
annual application for group experience rating by submitting an employer roster
for group rating plan (AC-25) for each group it sponsors. Each AC-25 shall:
(a) Be signed each year by an officer of the
sponsoring organization to which the members of the group belong;
(b) Identify each individual employer to be
included in the group policy year for which the group application is made;
and
(c) Identify whether, in the
previous policy year, each employer was:
(i)
Enrolled in the same group,
(ii)
Not enrolled in the same group, but enrolled in a different group sponsored by
the sponsoring organization, or
(iii) Not enrolled in the same group, and not
enrolled in a different group sponsored by the sponsoring
organization.
(2) In the manner specified by the bureau
of workers' compensation, the sponsoring
organization shall annually identify all employers that were enrolled in the
group in the previous policy year but are not enrolled in the group for the
policy year for which the current application is made and specify whether the employer is enrolled in
another group of the same sponsoring organization.
(3) The bureau may request from individual
employers or the sponsoring organization any additional information necessary
for the bureau to rule upon the application for group experience rating.
Failure or refusal of the sponsoring organization to provide the requested
information in the manner requested by the bureau shall be sufficient grounds
for the bureau to reject the application and refuse the group's participation
in group experience rating.
(4) A
sponsoring organization's application for group experience rating is effective
for a single policy year. Continuation of a group for subsequent years requires
timely filing of an application on a yearly basis and meeting eligibility
requirements set forth in rule
4123-17-61 of the Administrative
Code.
(B) Employer
requirements.
An employer electing to participate in group experience rating
must file an application for group rating (AC-26) with the sponsoring
organization of the group in which the employer seeks to participate. If the
sponsoring organization elects to include the employer in its group, the
sponsoring organization must file the AC-26 form electronically with the bureau
by the group experience rating application deadline set forth in the appendices
to rule 4123-17-74 of the Administrative
Code.
(1) An employer's AC-26 shall
remain in effect for all subsequent policy years when the employer remains in
the same group or another group sponsored by the same sponsoring
organization.
(2) The employer must
file an AC-26 if the employer applies for group experience rating with a
different sponsoring organization or was not group-experience rated in the
previous rating year.
(3) When an
employer files a new AC-26 or multiple AC-26 forms during the application
period, the latest-filed AC-26 shall establish the employer's intentions for
group experience rating. The employer's AC-26 shall remain effective until any
of the following occurs:
(a) The employer
timely files a subsequent AC-26 indicating the desire to participate in a group
with a different sponsor for the upcoming policy year;
(b) The sponsoring organization for the group
does not include the employer on the group roster (AC-25);
(c) The group does not reapply for group
experience rating or is rejected for failure to meet group eligibility
requirements; or
(d) The employer
fails to meet individual eligibility requirements set forth in paragraph (B) of
rule 4123-17-61 of the Administrative
Code.
(C) For
private employers, the sponsoring organization shall file applications on or
before the date identified in appendix A to rule
4123-17-74 of the Administrative
Code. For public employers, the sponsoring organization shall file applications
on or before the date identified in appendix B to rule
4123-17-74 of the Administrative
Code.
(1) Except as provided in
paragraph (B)(6) of rule
4123-17-61 of the Administrative Code,
the
sponsoring organization may not add an employer to a group after the
application deadline.
The sponsoring organization will be permitted to
correct a clerical error that results in an employer being omitted from a group
roster if:
(a) The sponsoring organization has
made an error in reporting the name or policy number of the employer on the
sponsoring organization's AC-25; or
(b) The sponsoring organization included the
employer on the sponsoring organization's AC-25 but failed to file the employer's AC-26 with the
bureau prior to the application deadline. The sponsoring organization must
provide sufficient documentation, as determined by the bureau, that the
employer timely filed its AC-26 with the sponsoring organization.
(2) A sponsoring organization that
has applied for group experience rating may not voluntarily terminate the
application during the bureau's evaluation period.
(3) Any changes to the sponsoring
organization's original application must be filed in a manner prescribed by the
bureau prior to the application deadline. Any rescissions made must be
completed in writing
and signed by an officer of the sponsoring
organization to which the members of the group belong. Any changes received by
the bureau after the application deadline will not be honored. The latest
application form or rescission received by the bureau prior to the application
deadline will be used to determine the premium obligation for the
group.
(D) A sponsoring
organization shall notify an employer that is participating in a group of that
sponsoring organization if the employer will not be included in a group by that
sponsoring organization for the next rating year.
(1) For private employer groups, the
sponsoring organization shall notify the employer in writing prior to the last
business day of October of the year of the group application deadline set forth
in appendix A to rule
4123-17-74 of the Administrative
Code.
(2) For public employer
taxing district groups, the sponsoring organization shall notify the employer
in writing prior to the last business day of April of the year of the group
application deadline set forth in appendix B to rule
4123-17-74 of the Administrative
Code.
(3) If an employer notifies
the bureau that a sponsoring organization has not complied with this
paragraph, and the sponsoring organization fails
to prove that the notice was provided in a timely manner, the bureau will,
without the approval of the sponsoring organization, allow the employer to
remain in the group for the rating year for which the notice was required. If
that group no longer exists the bureau will, without the approval of the
sponsoring organization, place the employer in a homogeneous group with the
same sponsoring organization or take other appropriate action.
(E) When the bureau determines
that individual employers in a proposed group do not meet the eligibility
requirements set forth in rule
4123-17-61 of the Administrative
Code, the bureau will notify the individual employers and the sponsoring
organization of its determination. The sponsoring organization may continue in
its application for group coverage without the disqualified employers, but the
group must meet minimum requirements of rule
4123-17-61 of the Administrative
Code.
(F) A sponsoring organization
may request that an employer be removed from its group for a gross
misrepresentation made on the employer's application to the group.
(1) "Gross misrepresentation" is an act by
the employer that would cause financial harm to the other members of the group,
and is limited to any of the following:
(a)
The sponsoring organization discovers that the employer applicant for group
experience rating has recently merged with one or more entities without
disclosing such merger on the employer's application for membership in the
group, and such merger adversely affects the experience modification (EM), as
defined in rule
4123-17-03 of the Administrative
Code, of the group.
(b) The
sponsoring organization discovers that the employer applicant for group
experience rating has failed to disclose the true nature of the employer's
business pursuit on its application for membership in the group, and this
failure adversely affects the EM of the group.
(2) Requests for removal of an employer
pursuant to this paragraph must be submitted within thirty days of the bureau's
notification to the sponsoring organization that a rate adjustment has
occurred. The sponsoring organization must notify the employer of its request
to remove the employer from the group for gross misrepresentation.
(3) The sponsoring organization must provide
sufficient documentation, as determined by the bureau, to support its request
to remove an employer from a group.
(4) The employer shall be removed from the
group only with the bureau's approval.
