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WV Code § 33-48-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 48. Model Health Plan for Uninsurable Individuals Act|§33-48-7. Funding of the Plan

(a) Premiums. --(1) The plan shall establish premium rates for plan coverage as provided in subdivision (2) of this subsection. Separate schedules of premium rates based on age, sex and geographical location may apply for individual risks. Premium rates and schedules shall be submitted to the commissioner for approval prior to use.(2) The plan, with the assistance of the commissioner, shall determine a standard risk rate by considering the premium rates charged by other insurers offering health insurance coverage to individuals. The standard risk rate shall be established using reasonable actuarial techniques and shall reflect anticipated experience and expenses for such coverage. Initial rates for plan coverage shall not be less than one hundred twenty-five percent of rates established as applicable for individual standard risks. Subject to the limits provided in this subdivision, subsequent rates shall be established to provide fully for the expected costs of claims including recovery of prior losses, expenses of operation, investment income of claim reserves and any other cost factors subject to the limitations described herein. In no event shall plan rates exceed one hundred fifty percent of rates applicable to individual standard risks.(b) Notwithstanding the provisions of subsection (c), section eight, article twenty-nine-b, chapter sixteen of this code and not to be construed as in conflict therewith, the Health Care Authority is authorized to increase the assessment obligation of hospitals in an amount not to exceed a maximum of twenty-five percent above the one tenth of one percent specified in said subsection and the entire assessment, including the additional assessment, shall be collected as specified in said subsection. Upon receipt of the additional assessment, the Health Care Authority shall transfer all proceeds generated from the additional assessment collected to the special revenue account established in section seven-a of this article. (c) The plan is authorized to receive and expend any federal grant.(d) With the consent of the board, the commissioner is authorized to utilize his or her administrative staff and resources in administering this article. The board shall reimburse the commissioner for all costs of administrative and actuarial services, supplies and other costs incurred by the commissioner in implementing the provisions of this article.
WV Code § 33-48-7a (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 48. Model Health Plan for Uninsurable Individuals Act|§33-48-7a. Special Revenue Account Created

(a) There is hereby created a special revenue account in the state Treasury, designated the "West Virginia Health Insurance Plan Fund", which shall be an interest-bearing account and may be invested in the manner permitted by article six, chapter twelve of this code, with the interest income a proper credit to the fund, unless otherwise designated in law. The fund shall be administered by the commissioner, under the supervision and control of the board, and used to pay all proper costs incurred in implementing the provisions of this article, all administrative costs of the plan, all claims and all proper ongoing costs of the plan. Moneys deposited into this account are available for expenditure as the commissioner may direct in accordance with the provisions of this article.(b) The following funds shall be paid into this account:(1) All premium payments received from individuals insured by the plan;(2) All other payments, gifts or income from any source; and(3) Transfers from the Health Care Authority of all proceeds generated from the additional assessment collected pursuant to subsection (b), section seven of this article at any time after July 1, 2004.
WV Code § 33-48-7b (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 48. Model Health Plan for Uninsurable Individuals Act|§33-48-7b. Surplus Available to Subsidize Premiums

Whenever the board determines that the account created pursuant to section seven-a of this article contains a surplus above those amounts necessary to provide fully for the expected costs of claims and other expenses listed in subsection (a), section seven of this article, the plan may use such surpluses to subsidize the premium of enrollees with an annual average household income at or below four hundred percent of the federal poverty level. The board may propose emergency rules and shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to establish eligibility criteria for enrollees who are eligible for premium subsidy pursuant to this section.
WV Code § 33-48-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 48. Model Health Plan for Uninsurable Individuals Act|§33-48-9. Collective Action

Neither the participation in the plan as participating insurers, the establishment of rates, forms or procedures nor any other joint or collective action required by this article shall be the basis of any legal action, criminal or civil liability or penalty against the plan or any participating insurer.
WV Code § 33-48-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 48. Model Health Plan for Uninsurable Individuals Act|§33-48-10. Taxation

The plan established pursuant to this article shall be exempt from the premium taxes assessed under sections fourteen and fourteen-a, article three of this chapter.
WV Code § 33-48-12 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 48. Model Health Plan for Uninsurable Individuals Act|§33-48-12. Effective Date

The provisions of this article shall become effective on July 1, 2004.
WV Code § 33-49-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-2. Definitions

(a) As used in this article, the term "flood" means a general and temporary condition of partial or complete inundation of two acres or more of normally dry land area or of two or more properties, at least one of which is the policyholder's property, from:(1) Overflow of waters;(2) Unusual and rapid accumulation or runoff of surface waters from any source;(3) Mudflow; or(4) Collapse or subsidence of land along the shore of a lake or similar body of water as a result of erosion or undermining caused by waves or currents of water exceeding anticipated cyclical levels which result in a flood.(b) As used in this article, the term "insurer" means an insurer that is subject to the provisions of this chapter and is offering flood insurance pursuant to this article: Provided, That a surplus lines insurer offering flood insurance pursuant to this article is exempt from the requirements of this chapter but subject to laws and rules applicable to surplus lines insurers.
WV Code § 33-49-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-3. Issuance of Flood Insurance

(a) Subject to the requirements of this article, an insurer may issue an insurance policy, contract or endorsement providing coverage for the peril of flood on any structure or on the contents of personal property on a form that has been filed with and approved by the commissioner pursuant to section eight, article six of this chapter and that may be substantially similar to the form used by the National Flood Insurance Program (NFIP).(b) A surplus lines agent may export a contract or endorsement providing flood coverage of $1 million or more to an eligible surplus lines insurer without making a diligent effort to seek such coverage from three or more authorized insurers as provided in article twelve-c of this chapter. This subsection expires on July 1, 2019.
WV Code § 33-49-4 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-4. Content of Flood Insurance

(a) At a minimum, coverage for the peril of flood must cover a flood as defined in this article. Coverage for the peril of flood may also include water intrusion, as defined by the policy, which originates from outside the structure and is not otherwise covered under the definition of flood.(b) An insurer may offer a flood coverage policy, contract or endorsement:(1) That has a flood deductible based on a stated dollar amount or a percentage of the coverage amount. At a minimum, an insurer must offer deductible amounts applicable to flood losses that equal the standard deductibles offered under the National Flood Insurance Program;(2) That provides that any flood loss will be adjusted on the basis of:(A) The actual cash value of the property; or(B) Replacement costs up to the policy limits in the same manner as provided under section nine, article seventeen of this chapter;(3) That restricts flood coverage to the principal building, as defined in the applicable policy;(4) In an agreed-upon amount, including coverage limited to the amount of all outstanding mortgages applicable to the covered property. However, if a policy, contract or endorsement does not limit flood coverage to the replacement cost of the covered property, the contract or endorsement may not include a provision penalizing the policyholder for not insuring the covered property up to replacement cost; or(5) That, as to the peril of flood, does not cover:(A) Additional living expenses;(B) Personal property or contents; or(C) Law and ordinance coverage. However, an insurer must offer law and ordinance coverage that is comparable to the law and ordinance coverage offered in the standard National Flood Insurance Program policy. A policy, endorsement, or contract that includes the law and ordinance coverage that must be offered under this paragraph must include the following disclosure in uppercase bold lettering of at least 12-point type:"LAW AND ORDINANCE COVERAGE UNDER THIS POLICY MIGHT HAVE LIMITATIONS ON WHAT IS COVERED IN THE EVENT OF A LOSS. YOU SHOULD CONSULT WITH YOUR AGENT IF YOU HAVE QUESTIONS ABOUT THE COVERAGE OFFERED UNDER THIS POLICY."
WV Code § 33-49-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-5. Notice of Availability and Limits of Flood Insurance

(a) A policy, endorsement or contract providing coverage for the peril of flood must provide notice that flood insurance coverage is available from the National Flood Insurance Program.(b) Any limitations on flood coverage or policy limits as to the peril of flood, including, but not limited to, flood deductibles or flood coverage limited to the amount of all outstanding mortgages, must be prominently disclosed on the declarations page or face page of the policy in uppercase bold lettering of at least 12-point type and be sufficiently clear so as to be readily understandable by both the agent and the property owner.(c) A policy that limits flood coverage to an amount less than the full replacement cost of the property must include the statement: "THIS POLICY LIMITS FLOOD COVERAGE TO LESS THAN THE FULL COST OF REPLACEMENT FOR THE PROPERTY, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU AND MAY PUT YOUR EQUITY IN THIS PROPERTY AT RISK."(d) A policy that insures a dwelling on the basis of actual cash value must include the statement: "THIS POLICY PAYS YOU THE DEPRECIATED VALUE OF YOUR PROPERTY THAT IS DAMAGED BY FLOOD, WHICH MAY RESULT IN HIGH OUT-OF-POCKET EXPENSES TO YOU IF YOUR PROPERTY NEEDS TO BE REPAIRED OR REPLACED."
WV Code § 33-49-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-6. Notice of Cancellation or Nonrenewal

A policy, endorsement or contract providing coverage for the peril of flood must require the insurer to give 45-days' prior written notice of cancellation or nonrenewal to the insured and any regulated lending institution or federal agency that is a mortgagee. An insurer or insured may cancel during the term of the policy or upon renewal if the cancellation is for a valid reason under the National Flood Insurance Program.
WV Code § 33-49-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-7. Additional Requirements

(a) In addition to any other applicable requirements, an insurer providing flood coverage in this state must:(1) Notify the office at least thirty days before writing flood insurance in this state; and(2) File a plan of operation and financial projections or revisions to such plan, as applicable, with the commissioner.
WV Code § 33-49-8 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-8. Conflicts Between Insurance Law and Flood Insurance

With respect to the regulation of flood insurance coverage written in this state by private insurers, this article supersedes any other provision in this chapter in the event of a conflict.
WV Code § 33-49-9 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-9. Federal Law Requiring Certification

If federal law or rule requires a certification by a state insurance regulatory official as a condition of qualifying for private flood insurance or disaster assistance, the commissioner shall provide the certification, and the certification is not subject to review under section fourteen, article two of this chapter.
WV Code § 33-49-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 49. Flood Insurance|§33-49-10. Rule-Making Authority

(a) The commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to implement the provisions of this article, including but not limited to:(1) Establishing and refining definitions;(2) Requirements for ratemaking, forms and other requirements under this chapter;(3) Clarifying minimum coverage requirements for flood insurance policies;(4) Determining whether a policy meets the definition of "private flood insurance" or other certain standards and requirements; and(5) Solvency and market conduct operations.(b) The commissioner may promulgate emergency rules pursuant to the provisions of section fifteen, article three, chapter twenty-nine-a of this code for any purposes set forth for legislative rules in subsection (a) of this section.
WV Code § 33-50-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 50. Patient Protection and Transparency Act|§33-50-1. Definitions

For the purposes of this article, the following words and terms mean the following:(1) "Commissioner" means the West Virginia Insurance Commissioner.(2) "Consumer" means an individual or family purchasing insurance coverage through the exchange.(3) "Exchange" means the West Virginia Health Benefit Exchange or an exchange website operated by the federal government.(4) "Health care provider" means a provider of medical or health services and any other person or organization who furnishes, bills or is paid for health care in the normal course of business.(5) "Health carrier" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health services.(6) "Network" means a group of health care providers that have contracted with a health plan to provide care at a discounted rate.(7) "Qualified health plan" means a health plan certified to be offered for sale through the exchange.(8) "West Virginia Health Benefit Exchange" means the government-regulated marketplace of qualified health plans with multiple levels of coverage established pursuant to article sixteen-g of this chapter.
WV Code § 33-50-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 50. Patient Protection and Transparency Act|§33-50-2. Information Available to the Public and Disclosures Required of Health Carriers

(a) The commissioner shall on his or her website provide information regarding the qualified health plans being offered for sale through the exchange in a format easily found by a consumer on such website. Information may be provided through links to specific information, including through links to the website of each health carrier offering a qualified health plan for sale through the exchange.(b) Information to be made available to consumers for each qualified health plan offered for sale through the exchange include:(1) The names of the physicians, hospitals and other health care providers that are in network;(2) A list of the types of specialists that are in network;(3) Exclusions from coverage by category of benefits;(4) Restrictions on use or quantity of covered items and services by category of benefits;(5) The dollar amount of copayments;(6) The percentage of coinsurance by item and service;(7) Required cost-sharing;(8) Information sufficient to determine whether a specific drug is available on formulary;(9) Clinical prerequisites or authorization requirements for coverage of specific drugs;(10) A description of how medications will be included in or excluded from the deductible;(11) A description of out-of-pocket costs that may not apply to the deductible for a medication;(12) Information sufficient to determine whether a specific drug is covered when furnished by a physician or clinic;(13) An explanation of the amount of coverage for out-of-network providers or noncovered services;(14) The process for a patient to appeal a health plan decision; and(15) Contact information for the qualified health plan.(c) The commissioner may require a qualified health plan to make the information listed in subsection (b) of this section available, including for website usage, and to provide for the reasonable updating of such information.(d) The commissioner's website should provide general information concerning the exchange, qualified health plans, health insurance terminology and other information consumers may need to assist them in making informed decisions concerning the purchase of a qualified health plan through the exchange.
WV Code § 33-50-3 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 50. Patient Protection and Transparency Act|§33-50-3. Rule-Making Authority

The commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to implement the provisions of this article.
WV Code § 33-51-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 51. Pharmacy Audit Integrity Act|§33-51-1. Short Title

This article may be cited and known as the Pharmacy Audit Integrity Act.
WV Code § 33-51-2 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 51. Pharmacy Audit Integrity Act|§33-51-2. Scope

This article covers any audit of the records of a pharmacy conducted by a managed care company, third-party payer, pharmacy benefits manager or an entity that represents a covered entity, or health benefit plan, the registration of auditing entities, and the licensure and regulation of pharmacy benefits managers.
WV Code § 33-51-5 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 51. Pharmacy Audit Integrity Act|§33-51-5. Appeals Process

A pharmacy may appeal a final audit report in accordance with the procedures established by the entity conducting the pharmacy audit.
WV Code § 33-51-6 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 51. Pharmacy Audit Integrity Act|§33-51-6. Limitations

(a) The provisions of this article do not apply to an investigative audit of pharmacy records when:(1) Fraud, waste, abuse or other intentional misconduct is indicated by physical review or review of claims data or statements; or(2) Other investigative methods indicate a pharmacy is or has been engaged in criminal wrongdoing, fraud or other intentional or willful misrepresentation. (b) This article does not supersede any audit requirements established by federal law.
WV Code § 33-51-7 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 51. Pharmacy Audit Integrity Act|§33-51-7. Pharmacy Benefits Manager and Auditing Entity Registration

(a) Prior to conducting business in the State of West Virginia, except as provided in subsection (d) of this section, an auditing entity shall register with the Insurance Commissioner. The commissioner shall make an application form available on its publicly accessible Internet website that includes a request for the following information: (1) The identity, address, and telephone number of the applicant;(2) The name, business address, and telephone number of the contact person for the applicant; and(3) When applicable, the federal employer identification number for the applicant.(b) Term and fee. —(1) The term of registration shall be two years from the date of issuance. (2) The Insurance Commissioner shall determine the amount of the initial application fee and the renewal application fee for the registration. Such fee shall be submitted by the applicant with an application for registration. An initial application fee is nonrefundable. A renewal application fee shall be returned if the renewal of the registration is not granted.(3) The amount of the initial application fees and renewal application fees must be sufficient to fund the Insurance Commissioner's duties in relation to its responsibilities under this article, but a single fee may not exceed $1,000.(c) Registration. —(1) The Insurance Commissioner shall issue a registration, as appropriate, to an applicant when the Insurance Commissioner determines that the applicant has submitted a completed application and paid the required registration fee.(2) The registration may be in paper or electronic form, is nontransferable, and shall prominently list the expiration date of the registration.(d) Duplicate registration. —(1) A licensed insurer or other entity licensed by the commissioner pursuant to this chapter shall comply with the standards and procedures of this article but is not required to separately register as an auditing entity.(2) A pharmacy benefits manager that is registered as a third-party administrator pursuant to §33-46-1 et seq. of this code shall comply with the standards and procedures of this article but is not required to register separately as an auditing entity.
WV Code § 33-51-10 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 51. Pharmacy Audit Integrity Act|§33-51-10. Commissioner Required to Propose Rules

The Insurance Commissioner shall propose rules for legislative approval in accordance with 29A-3-1 et seq. of this code that are necessary to effectuate the provisions of this article.
WV Code § 33-52-1 (2021)
2021 West Virginia Code|Chapter 33. Insurance|Article 52. Corporate Governance Annual Disclosure Act|§33-52-1. Short Title, Purpose and Scope of Article

(a) This article may be cited as the "Corporate Governance Annual Disclosure Act".(b) The purpose of this article is to:(1) Provide the commissioner a summary of an insurers or insurance groups corporate governance structure, policies and practices to permit the commissioner to gain and maintain an understanding of the insurers corporate governance framework;(2) Outline the requirements for completing a corporate governance annual disclosure with the commissioner;(3) Set forth the procedures for filing the corporate governance annual disclosure; and (4) Provide for the confidential treatment of the corporate governance annual disclosure and related information that will contain confidential and sensitive information related to an insurer or insurance groups internal operations and proprietary and trade secret information which, if made public, could potentially cause the insurer or insurance group competitive harm or disadvantage. (c) Nothing in this article limits the commissioners examination authority, or the rights or obligations of third parties, under §33-2-9 of this code.(d) The requirements of this article apply to all licensed insurers domiciled in this state.