reglab/housing_qa huggingface dataset:
WY Stat § 26-38-209 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 38 - Long-Term Care Insurance|Article 2 - Medicare Supplement Insurance|Section 26-38-209 - Penalties.

26-38-209. Penalties.| (a) In addition to any other applicable penalties for violations of this code, the commissioner may:  (i) Require insurers to cease marketing any Medicare supplement policy or certificate in this state which violates any provision of this act, any other law administered by the commissioner, any regulation promulgated pursuant to this act or any other rule promulgated pursuant to the authority of the commissioner; or  (ii) Require the insurer to take any actions necessary to comply with the provisions of this act.
WY Stat § 26-40-101 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 40 - Healthcare Claims Under Specified Standards|Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis|Section 26-40-101 - Scope.

26-40-101. Scope.| This chapter applies to all insurers who solicit or offer for sale in this state individual, group disability or blanket disability policies covering Wyoming residents.
WY Stat § 26-40-102 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 40 - Healthcare Claims Under Specified Standards|Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis|Section 26-40-102 - Definitions.

26-40-102. Definitions.| (a) As used in this chapter:  (i) "Health care provider" means any physician, hospital or other person licensed or otherwise authorized in this or another state to furnish to any individual medical or dental care, vision care or hospitalization incident to the furnishing of that care or hospitalization for the purpose of preventing, alleviating, curing or healing human illness, injury or physical disability;  (ii) "Usual, customary and reasonable basis" means the method by which an insurer determines the amount to be paid on a claim for disability benefits by comparing the amount of the claim to amounts charged by other health care providers for the same or similar medical services or procedures;  (iii) "Medical necessity," means:  (A) A medical service, procedure or supply provided for the purpose of preventing, diagnosing or treating an illness, injury, disease or symptom and is a service, procedure or supply that:  (I) Is medically appropriate for the symptoms, diagnosis or treatment of the condition, illness, disease or injury;  (II) Provides for the diagnosis, direct care and treatment of the patient's condition, illness, disease or injury;  (III) Is in accordance with professional, evidence based medicine and recognized standards of good medical practice and care; and  (IV) Is not primarily for the convenience of the patient, physician or other health care provider.  (B) A medical service, procedure or supply shall not be excluded from being a medical necessity under this section solely because the service, procedure or supply is not in common use if the safety and effectiveness of the service, procedure or supply is supported by:  (I) Peer reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia and other medical literature that meet the criteria of the National Institutes of Health's Library of Medicine for indexing in Index Medicus (Medline) and Elsevier Science Ltd. for indexing in Excerpta Medicus (EMBASE); or  (II) Medical journals recognized by the Secretary of Health and Human Services under Section 1861(t)(2) of the federal Social Security Act.
WY Stat § 26-40-103 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 40 - Healthcare Claims Under Specified Standards|Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis|Section 26-40-103 - Payment of Claims.

26-40-103. Payment of claims.| (a) If any disability insurance policy provides for settlement of a claim for payment of medical services or procedures provided by a health care provider using a usual, customary and reasonable basis the insurer shall:  (i) Submit to the department upon request statistical data of health care provider's charges on which the insurer bases payment of claims. Such data shall be submitted upon request of the commissioner, provided, however, no insurer may be required to submit data more than once every six (6) months. The data submitted shall contain only charges for services performed not more than one (1) year prior to the date of the most recent data;  (ii) Provide to the claimant, in writing, a complete explanation of the basis of settlement, if requested by the claimant in writing, and maintain the explanation in the claim file. If the basis of payment is less than the actual charge made by the health care provider, the explanation shall state the specific reason for the amount not paid and may not expressly state that the health care provider is overcharging unless the allegation is substantiated by fact set out in the explanation;  (iii) Settle any claim for medical services or procedures only on the basis of charges made by Wyoming health care providers of similar qualifications or experience for the same or similar medical services or procedures if the service or procedure for which payment is sought was obtained in Wyoming. However, if the profile or survey does not contain a statistically credible sample of charges, the insurer may include in the profile or survey charges from another similar geographic and demographic area so that a reliable basis is established.  (b) Statistical data submitted to the department pursuant to this section shall be confidential in nature and not available for public inspection.  (c) When a disability insurance policy provides for settlement of a claim for payment of medical services or procedures provided by a health care provider using a usual, customary and reasonable basis or any similar basis:  (i) If the commissioner, based either on a review of the statistical data submitted pursuant to subsection (a) of this section or on the receipt of complaints from one (1) or more insureds, has reason to suspect that a claim or one (1) or more classes of claims is not being settled on the basis provided by the policy he may order the company to show cause why the settlement or settlements should not be changed;  (ii) If the commissioner finds, after notice and opportunity for hearing, that the company is not settling a claim or one (1) or more classes of claims on the basis provided by the policy, he may order a different settlement or settlements.
WY Stat § 26-40-104 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 40 - Healthcare Claims Under Specified Standards|Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis|Section 26-40-104 - Prohibitions.

26-40-104. Prohibitions.| (a) No person may make payment on a claim for benefits under an individual, group or blanket disability policy covering residents of this state unless such claim payment is made in compliance with this chapter.  (b) Any person who violates any provisions of this chapter is subject to denial, suspension or revocation of a license or certificate of authority in addition to the imposition of any other penalty provided by W.S. 26-1-107.
WY Stat § 26-43-104 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-104 - Administrator.

26-43-104. Administrator.| (a) The board shall select an insurer, insurers or a third party administrator or administrators through a competitive bidding process to administer the pool. The board shall evaluate bids based on criteria established by the board which shall include but are not limited to:  (i) The proven ability of the administrator to handle individual accident and health insurance;  (ii) The efficiency of the claim paying procedures of the administrator;  (iii) An estimate of total charges for administering the plan;  (iv) The ability of the administrator to administer the pool in a cost efficient manner.  (b) The administrator shall serve for a period determined by the board of not less than three (3) years and not more than five (5) years and is subject to removal for cause. At least one (1) year prior to the expiration of the period of service by an administrator, the board shall invite all insurers, including the current administrator to submit bids to serve as the administrator for the succeeding period. Selection of the administrator for the succeeding period shall be made at least six (6) months prior to the end of the current period.  (c) The administrator shall:  (i) Perform all eligibility and administrative claims payment functions relating to the pool;  (ii) Establish a premium billing procedure for collection of premiums from insureds. Billings shall be made periodically as determined by the board;  (iii) Perform all necessary functions to assure timely payment of benefits to covered persons under the pool including but not limited to:  (A) Making available information relating to the proper manner of submitting a claim for benefits to the pool and distributing forms upon which submission is made;  (B) Evaluating the eligibility of each claim for payment by the pool.  (iv) Submit regular reports to the board regarding the pool operation. The board shall determine the frequency, content and form of the report;  (v) Determine net written and earned premiums, the expense of administration and the paid and incurred losses for the year and report the information to the board and the department on a form and in the manner prescribed by the commissioner;  (vi) Receive payment as provided in the plan of operation for its expenses incurred in the performance of its services.
WY Stat § 26-43-106 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-106 - Minimum Benefits; Limitations.

26-43-106. Minimum benefits; limitations.| (a) Pool coverage shall be offered to eligible persons subject to the termination and disenrollment provisions of W.S 26-43-103(e). The commissioner shall establish by rule and regulation the pool coverage, its schedule of benefits, exclusions and other limitations consistent with this act and taking into consideration the advice and recommendations of the board and the health benefits plan committee created pursuant to W.S. 26-2-132. The commissioner and the board annually shall review the pool coverage, its schedule of benefits, exclusions and limitations and make changes to reflect the levels of health insurance coverage provided in this state.  (b) In establishing the pool coverage, the commissioner shall:  (i) Consider the levels of health insurance provided in the state, medical economic factors deemed appropriate and the advice and recommendations of the board;  (ii) Promulgate benefit levels, deductibles, coinsurance factors, exclusions and limitations determined to be generally reflective of and commensurate with health insurance plans marketed in the state and required by this act. The commissioner shall offer at least two (2) plans that may include a higher deductible option or a health savings account option in order to provide less expensive coverage alternatives for pool participants;  (iii) Repealed by Laws 2005, ch. 57, § 2.  (iv) Repealed By Laws 2005, ch. 57, § 2.  (v) Design and employ cost containment measures and controls which may include but are not limited to, preadmission certification, concurrent inpatient review, case management, utilization reviews, exclusions or limitations concerning treatment and services, and member deductibles;  (vi) Offer for those individuals described in W.S. 26-43-103(d) a catastrophic health plan having a deductible level of twenty-five thousand dollars ($25,000.00), subject to the termination and disenrollment provisions of W.S. 26-43-103(e).  (c) Pool coverage shall not include medical costs associated with:  (i) Repealed by Laws 2019, ch. 16, § 2.  (ii) Cosmetic surgery;  (iii) Other procedures as determined by the board.  (d) Repealed by Laws 2019, ch. 16, § 2.
WY Stat § 26-43-107 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-107 - Premiums; Standard Risk Rate.

26-43-107. Premiums; standard risk rate.| (a) Separate schedules of premium rates based on plan coverage under the pool, age, sex and geographical location may apply for individual risks.  (b) The board shall determine the standard risk rate by calculating the average individual standard rate charged by the five (5) largest insurers offering coverages in the state comparable to each plan coverage under the pool. If five (5) insurers do not offer comparable coverage, the standard risk rate shall be established using reasonable actuarial techniques and shall reflect anticipated experience and expenses for the applicable coverage.  (c) Initial rates for pool coverage in the first year coverage is provided pursuant to this act shall not be less than one hundred fifty percent (150%) of rates established as applicable for individual standard risks. Subsequent rates may provide for the expected costs of claims including recovery of prior losses, expenses of operation, investment income of claim reserves, and any other costs factors subject to the limitations provided by this subsection. Beginning July 1, 2007, except as provided in subsection (e) of this section, there shall be two (2) levels of eligibility. Level one (1) eligibility applies to persons with income equal to or greater than two hundred fifty percent (250%) of the federal poverty guideline. Level two (2) eligibility applies to persons with income below two hundred fifty percent (250%) of the federal poverty guideline. Premium rates for level one (1) eligibility shall be set at one hundred fifty percent (150%) to two hundred five percent (205%) of rates applicable to individual standard risks. Premium rates for level two (2) eligibility shall be set at one hundred percent (100%) to one hundred forty percent (140%) of rates applicable to individual standard risks. All rates and rate schedules shall be submitted to the commissioner for approval. The rates shall be set as close as practical to the lower end of the range provided.  (d) Premiums collected pursuant to this section shall be paid to the state treasurer and credited to the account.  (e) Repealed by Laws 2019, ch. 16, § 2.
WY Stat § 26-43-108 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-108 - Preexisting Conditions.

26-43-108. Preexisting conditions.| (a) Pool coverage shall not exclude charges or expenses incurred for longer than the first twelve (12) months following the effective date of coverage as to any condition for which during the six (6) month period immediately preceding the effective date of coverage medical advice, care or treatment was recommended or received. The preexisting coverage limitation set forth in this section shall not apply to a federally defined eligible individual.  (b) Preexisting condition exclusions shall be waived to the extent to which similar exclusions, if any, have been satisfied under any prior health insurance coverage which was terminated and coverage in the pool is effective from the date on which the prior coverage was terminated if application for pool coverage is made not later than ninety (90) days following the termination.
WY Stat § 26-43-109 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-109 - Benefit Payments Reduction.

26-43-109. Benefit payments reduction.| (a) Benefits otherwise payable under pool coverage are reduced by:  (i) All amounts paid or payable through any other health insurance or insurance arrangement;  (ii) All hospital and medical expense benefits paid or payable under any workers' compensation coverage or automobile medical payment or liability insurance whether provided on the basis of fault or nonfault; and  (iii) Any hospital or medical benefits paid or payable under or provided pursuant to any state or federal law or program except Medicaid.  (b) The administrator or the board has a cause of action against an eligible person for the recovery of the amount of benefits paid which are not for covered expenses. Benefits due from the pool may be reduced or refused as a setoff against any amount recoverable under this section.
WY Stat § 26-43-110 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-110 - Immunity.

26-43-110. Immunity.| The participation in the pool as members, the establishment of rates, forms or procedures or any other joint or collective action required by this act shall not be the basis of any legal action, criminal or civil liability or penalty against the board, the pool or pool members.
WY Stat § 26-43-111 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-111 - Tax Exemption.

26-43-111. Tax exemption.| The pool established pursuant to this act is exempt from insurance premium taxes.
WY Stat § 26-43-112 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-112 - Account Created; Payments; Investment.

26-43-112. Account created; payments; investment.| There is created an account within the trust and agency fund in which all money received, earned or collected pursuant to this act shall be credited and continuously appropriated for the purposes of this act. All claims, costs of administration and other necessary expenses incurred pursuant to this act shall be paid from the account. All money in the account not immediately necessary for the purposes of this act, which amount is certified by the board to the state treasurer, shall be invested and any interest earned shall be credited to the account.
WY Stat § 26-43-113 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-113 - Termination of Provisions.

26-43-113. Termination of provisions.| This act is not effective after June 30, 2030.
WY Stat § 26-43-114 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 1 - Wyoming Health Insurance Pool Act|Section 26-43-114 - Enrollment Capacity Planning.

26-43-114. Enrollment capacity planning.| The board shall annually estimate the funds available to the plan through premiums, assessments and legislative appropriations for the subsequent fiscal year and shall determine the maximum number of individuals who may be enrolled for that year without incurring total costs of operation in excess of estimated available funds. The board shall take steps necessary to assure that plan enrollment does not exceed the maximum enrollment capacity determined for that year. In determining enrollment capacity for purposes of this section, the board shall provide for the enrollment in the pool of all federally eligible individuals.
WY Stat § 26-43-301 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 3 - Air Ambulance Membership Organizations|Section 26-43-301 - Definitions; Applicability.

26-43-301. Definitions; applicability.| (a) As used in this article, "air ambulance membership organization" means an entity that, in exchange for fees, dues, charges or other consideration, provides:  (i) Discounts to members for the cost of services the organization provides as an air ambulance service company; or  (ii) Access for members to providers of air ambulance services and the right to receive air ambulance services from those providers. For purposes of this paragraph, "air ambulance membership organization" means the entity that contracts with health care providers, individuals, employees, groups, provider networks or other air ambulance membership organizations to offer access to air ambulance services and that determines the fees, dues, or charges to air ambulance membership organization members.  (b) The registration requirements of this article shall not apply to:  (i) An air ambulance membership organization that is otherwise subject to the provisions of this title and is required to be licensed under this title;  (ii) A health care provider who provides discounts to patients without any cost or fee of any kind to the patient.
WY Stat § 26-43-302 (2021)
2021 Wyoming Statutes|Title 26 - Insurance Code|Chapter 43 - Health Care|Article 3 - Air Ambulance Membership Organizations|Section 26-43-302 - Air Ambulance Membership Organizations; Certificate of Registration; Application.

26-43-302. Air ambulance membership organizations; certificate of registration; application.| (a) An air ambulance membership organization shall obtain a certificate of registration from the commissioner before operating as an air ambulance membership organization in Wyoming.  (b) An air ambulance membership organization seeking a certificate of registration from the commissioner shall apply on a form created and prescribed by the commissioner. The application shall include:  (i) An application fee not to exceed five hundred dollars ($500.00);  (ii) Information regarding whether a previous application for a certificate of registration under this article or for a substantially similar certificate under the laws of another state has been denied, revoked, suspended or terminated;  (iii) Information regarding whether the applicant is currently under investigation or the subject of any pending action and whether the applicant has been found in violation of any statute or regulation in any jurisdiction in the last five (5) years;  (iv) Information sufficient for the commissioner to determine whether the applicant has adequate expertise and experience to operate an air ambulance membership organization and is of good character;  (v) Certification that the applicant has established a dedicated toll-free telephone number for its customers and an internet website that makes available the names and addresses of all current air ambulance providers with which the applicant has contracted directly or through a provider network;  (vi) Proof that the applicant has posted a surety bond and has established a reserve fund as required by W.S. 26-43-305(f).  (c) Upon receipt of an application, the commissioner shall review the application and shall notify the applicant of any deficiencies in the application not later than twenty-one (21) days after receiving the application. Not more than ninety (90) days after receipt of an application containing all required information, the commissioner shall issue a certificate of registration to an applicant that has satisfied all requirements imposed by this article.  (d) A certificate of registration issued under this section shall be effective for one (1) year after the date of issuance unless renewed as provided by W.S. 26-43-303(a).