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Book Entry Legal Deposit Mike DeWine, Governor Jon Hosted, Lt Governor Judith L. French, Directorial Division, 50 W Town Street, 3rd Floor Suite 300, Columbus OH 43215 6146442683 | 6146443478 (Fax)
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How to fill out insurer and direct participantmember

01
To fill out insurer information, you will need to provide the insurance company's name, policy number, contact phone number, and address.
02
To fill out direct participant/member information, you will need to provide the individual's name, date of birth, contact information, and any relevant membership identification.

Who needs insurer and direct participantmember?

01
Insurer information is needed by individuals who are seeking reimbursement or coverage for services or products from their insurance provider.
02
Direct participant/member information is needed by organizations or businesses who are managing memberships or providing services directly to individuals.
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An insurer is a company that provides insurance coverage to policyholders. A direct participant member is an entity or individual who participates directly in an insurance program or plan, typically by being insured or providing insurance services.
Entities that act as insurers or direct participant members involved in certain insurance programs are required to file the necessary documentation, including insurance companies, health care providers, and other organizations managing or participating in insurance policies.
Filling out insurer and direct participant member documentation typically involves providing accurate and complete information about the organization, including details about policies, coverage, member data, and financial aspects as specified in the filing guidelines.
The purpose is to ensure compliance with regulatory requirements, to provide transparency in insurance practices, and to facilitate the monitoring of insurance activities for consumer protection and market stability.
Information that must be reported includes the name and address of the insurer or participant, types of insurance products offered, member details, coverage limits, financial information, and records of claims and policyholders.
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