reglab/statecodes huggingface dataset:
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-201 - Definitions.

26-48-201. Definitions.
(a) As used in this article:
(i) "Adjusted RBC report" means an RBC report which has been adjusted by the commissioner in accordance with W.S. 26-48-202(c);
(ii) "Corrective order" means an order issued by the commissioner specifying corrective actions which the commissioner has determined are required;
(iii) "Domestic health organization" means a health organization domiciled in this state;
(iv) "Foreign health organization" means a health organization that is licensed to do business in this state but is not domiciled in this state;
(v) "Health organization" means a health maintenance organization, limited health service organization, dental or vision plan, hospital, medical and dental indemnity or service corporation or other managed care organization licensed under chapter 3 or chapter 34 of this title. This definition does not include an organization that is licensed as either a life and health insurer or a property and casualty insurer as defined in W.S. 26-48-101(a)(xiii) and (xiv) and that is otherwise subject to either the life or property and casualty risk based capital requirements of W.S. 26-48-101 through 26-48-112;
(vi) "NAIC" means the National Association of Insurance Commissioners;
(vii) "RBC" means risk-based capital;
(viii) "RBC instructions" means the RBC report including risk-based capital instructions adopted by the commissioner, and as may be amended by the commissioner;
(ix) "RBC level" means a health organization's company action level RBC, regulatory action level RBC, authorized control level RBC or mandatory control level RBC where:
(A) "Company action level RBC" means, with respect to any health organization, the product of two (2) and its authorized control level RBC;
(B) "Regulatory action level RBC" means the product of one and one-half (1.5) and its authorized control level RBC;
(C) "Authorized control level RBC" means the number determined under the risk-based capital formula in accordance with the RBC instructions;
(D) "Mandatory control level RBC" means the product of seven-tenths (.7) and the authorized control level RBC.
(x) "RBC plan" means a comprehensive financial plan containing the elements specified in W.S. 26-48-203(b). If the commissioner rejects the RBC plan, and it is revised by the health organization, with or without the commissioner's recommendation, the plan shall be called the "revised RBC plan";
(xi) "RBC report" means the report required in W.S. 26-48-202;
(xii) "Total adjusted capital" means the sum of:
(A) A health organization's statutory capital and surplus as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed under W.S. 26-3-123 or 26-34-110; and
(B) Such other items, if any, as the RBC instructions may provide.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-202 - Risk-Based Capital Reports.

26-48-202. Risk-based capital reports.
(a) A domestic health organization shall, annually on or prior to March 1, prepare and submit to the commissioner a report of its RBC levels as of the end of the calendar year just ended, in a form and containing information as required by the RBC instructions. In addition, every domestic health organization shall file its RBC report:
(i) With the NAIC in accordance with the RBC instructions; and
(ii) With the insurance commissioner in any state in which the health organization is authorized to do business, if the insurance commissioner has notified the health organization of its request in writing, in which case the health organization shall file its RBC report not later than the later of:
(A) Fifteen (15) days from the receipt of notice to file its RBC report with that state; or
(B) March 1.
(b) A health organization's RBC shall be determined in accordance with the formula set forth in the RBC instructions and this article. The formula shall take the following into account, and may adjust for the covariance between the following which are determined in each case by applying the factors in the manner set forth in the RBC instructions:
(i) Asset risk;
(ii) Credit risk;
(iii) Underwriting risk; and
(iv) All other business risks and other relevant risks as are set forth in the RBC instructions.
(c) If a domestic health organization files an RBC report which in the judgment of the commissioner is inaccurate, the commissioner shall adjust the RBC report to correct the inaccuracy and shall notify the health organization of the adjustment. The notice shall contain a statement of the reasons for the adjustment. An RBC report as so adjusted is referred to as an "adjusted RBC report".
(d) An excess of capital over the amount produced by the risk-based capital requirements contained in this article and the formulas, schedules and instructions referenced in this article is desirable in the business of health insurance. Accordingly, health organizations should seek to maintain capital above the RBC levels required by this article. Additional capital is used and useful in the insurance business and helps to secure a health organization against various risks inherent in, or affecting, the business of insurance and not accounted for or only partially measured by the risk-based capital requirements contained in this article.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-205 - Authorized Control Level Event.

26-48-205. Authorized control level event.
(a) "Authorized control level event" means any of the following events:
(i) The filing of an RBC report by the health organization that indicates that the health organization's total adjusted capital is greater than or equal to its mandatory control level RBC but less than its authorized control level RBC;
(ii) The notification by the commissioner to the health organization of an adjusted RBC report that indicates the event in paragraph (i) of this subsection, provided the health organization does not challenge the adjusted RBC report under W.S. 26-48-207;
(iii) If the health organization challenges an adjusted RBC report that indicates the event in paragraph (i) of this subsection under W.S. 26-48-207, notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge;
(iv) The failure of the health organization to respond, in a manner satisfactory to the commissioner, to a corrective order, provided the health organization has not challenged the corrective order under W.S. 26-48-207; or
(v) If the health organization has challenged a corrective order under W.S. 26-48-207 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the health organization to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.
(b) In the event of an authorized control level event with respect to a health organization, the commissioner shall:
(i) Take such actions as are required under W.S. 26-48-204 regarding a health organization with respect to which a regulatory action level event has occurred; or
(ii) If the commissioner deems it to be in the best interests of the policyholders and creditors of the health organization and of the public, take any actions as are necessary to cause the health organization to be placed under regulatory control under chapter 28 of this code. In the event the commissioner takes such actions, the authorized control level event shall be deemed sufficient grounds for the commissioner to take action under chapter 28, and the commissioner shall have the rights, powers and duties with respect to the health organization as are set forth in chapter 28. In the event the commissioner takes actions under this paragraph pursuant to an adjusted RBC report, the health organization shall be entitled to such protections as are afforded to health organizations under the provisions of chapter 28 pertaining to summary proceedings.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-206 - Mandatory Control Level Event.

26-48-206. Mandatory control level event.
(a) "Mandatory control level event" means any of the following events:
(i) The filing of an RBC report which indicates that the health organization's total adjusted capital is less than its mandatory control level RBC;
(ii) Notification by the commissioner to the health organization of an adjusted RBC report that indicates the event in paragraph (i) of this subsection, provided the health organization does not challenge the adjusted RBC report under W.S. 26-48-207; or
(iii) If the health organization challenges an adjusted RBC report that indicates the event in paragraph (i) of this subsection under W.S. 26-48-207, notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(b) In the event of a mandatory control level event, the commissioner shall take such actions as are necessary to place the health organization under regulatory control under chapter 28 of this code. In that event, the mandatory control level event shall be deemed sufficient grounds for the commissioner to take action under chapter 28, and the commissioner shall have the rights, powers and duties with respect to the health organization as are set forth in chapter 28. If the commissioner takes actions pursuant to an adjusted RBC report, the health organization shall be entitled to the protections of chapter 28 pertaining to summary proceedings. Notwithstanding any of the foregoing, the commissioner may forego action for up to ninety (90) days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety (90) day period.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-207 - Hearings.

26-48-207. Hearings.
(a) A health organization shall have the right to an administrative hearing, on a record, at which the health organization may challenge any of the following determinations or actions by the commissioner:
(i) Notification to a health organization by the commissioner of an adjusted RBC report;
(ii) Notification to a health organization by the commissioner that:
(A) The health organization's RBC plan or revised RBC plan is unsatisfactory; and
(B) The notification constitutes a regulatory action level event with respect to the health organization.
(iii) Notification to any health organization by the commissioner that the health organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health organization to eliminate the company action level event with respect to the health organization in accordance with its RBC plan or revised RBC plan; or
(iv) Notification to a health organization by the commissioner of a corrective order with respect to the health organization.
(b) A health organization seeking a hearing under this section shall notify the commissioner of its request for a hearing within five (5) days after the notification by the commissioner under subsection (a) of this section. Upon receipt of the health organization's request for a hearing, the commissioner shall set a date for the hearing, which shall be no less than ten (10) nor more than thirty (30) days after the date of receipt of the health organization's request.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-209 - Supplemental Provisions; Rules; Exemptions.

26-48-209. Supplemental provisions; rules; exemptions.
(a) The provisions of this article are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the commissioner under such laws, including, but not limited to, W.S. 26-3-115, 26-3-116, 26-28-101 through 26-28-131, 26-34-121 and 26-34-123.
(b) The commissioner may adopt reasonable rules necessary for the implementation of this article.
(c) The commissioner may exempt from the application of this article a domestic health organization that:
(i) Writes direct business only in this state;
(ii) Assumes no reinsurance in excess of five percent (5%) of direct premium written, and:
(A) Writes direct annual premiums for comprehensive medical business of two million dollars ($2,000,000.00) or less; or
(B) Is a limited health service organization that covers less than two thousand (2,000) lives.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-210 - Foreign Health Organizations.

26-48-210. Foreign health organizations.
(a) A foreign health organization shall, upon the written request of the commissioner, submit to the commissioner an RBC report as of the end of the calendar year just ended by the later of:
(i) The date an RBC report would be required to be filed by a domestic health organization under this article; or
(ii) Fifteen (15) days after the request is received by the foreign health organization.
(b) A foreign health organization shall, at the written request of the commissioner, promptly submit to the commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.
(c) In the event of a company action level event, regulatory action level event or authorized control level event with respect to a foreign health organization as determined under the RBC statute applicable in the state of domicile of the health organization, or, if no RBC statute is in force in that state, under the provisions of this article, if the insurance commissioner of the state of domicile of the foreign health organization fails to require the foreign health organization to file an RBC plan in the manner specified under that state's RBC statute, or, if no RBC statute is in force in that state, under W.S. 26-48-203, the commissioner may require the foreign health organization to file an RBC plan with the commissioner. In such event, the failure of the foreign health organization to file an RBC plan with the commissioner shall be grounds to order the health organization to cease and desist from writing new insurance business in this state.
(d) In the event of a mandatory control level event with respect to a foreign health organization, if no domiciliary receiver has been appointed with respect to the foreign health organization under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign health organization, the commissioner may make application to the district court of Laramie county as permitted under chapter 28 of this code. The occurrence of the mandatory control level event shall be considered adequate grounds for the application.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-211 - Immunity.

26-48-211. Immunity.
There shall be no liability on the part of, and no cause of action shall arise against, the commissioner or the insurance department or its employees or agents for any action taken by them in the performance of their powers and duties under this article.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 48 - Risk-Based Capital › Article 2 - Risk-Based Capital for Health Organizations › Section 26-48-212 - Notices.

26-48-212. Notices.
All notices by the commissioner to a health organization that may result in regulatory action under this article shall be effective upon dispatch if transmitted by registered or certified mail, or in the case of any other transmission shall be effective upon the health organization's receipt of notice.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 49 - Service Contracts › Section 26-49-101 - Scope and Purposes.

26-49-101. Scope and purposes.
(a) The purpose of this article is to create a legal framework within which service contracts may be sold in this state.
(b) The following are exempt from W.S. 26-49-103 through 26-49-111:
(i) Warranties;
(ii) Maintenance agreements;
(iii) Warranties, service contracts and maintenance agreements offered by public utilities on their transmission devices to the extent they are regulated by public service commission; and
(iv) Service contracts sold or offered for sale to persons other than consumers.
(c) The types of agreements referred to in subsection (b) of this section do not have to comply with any provision of the insurance law of this state.
(d) This article does not apply to:
(i) Mechanical breakdown insurers licensed pursuant to chapter 37 of this code;
(ii) To mechanical breakdown insurance organizations who maintain a license pursuant to W.S. 26-37-106;
(iii) To motor club services regulated pursuant to the Motor Club Services Act;
(iv) Theft protection programs or their accompanying warranties except that theft protection programs and their accompanying warranties shall be subject to the enforcement provisions of W.S. 26-49-110.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 49 - Service Contracts › Section 26-49-104 - Required Provisions; Reimbursement Insurance Policy.

26-49-104. Required provisions; reimbursement insurance policy.
(a) Reimbursement insurance policies insuring service contracts issued, sold or offered for sale in this state shall state that the insurer that issued the reimbursement insurance policy shall reimburse or pay on behalf of the provider any covered sums the provider is legally obligated to pay or shall provide the service which the provider is legally obligated to perform according to the provider s contractual obligations under the insured service contracts issued or sold by the provider.
(b) In the event covered service is not provided by the service contract provider within sixty (60) days of proof of loss by the service contract holder, the contract holder is entitled to apply directly to the reimbursement insurance company.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 49 - Service Contracts › Section 26-49-106 - Prohibited Acts.

26-49-106. Prohibited acts.
(a) A provider shall not use in its name the words insurance, casualty, surety, mutual or any other words descriptive of the insurance, casualty or surety business; or a name deceptively similar to the name or description of any insurance or surety corporation, or to the name of any other provider. The word "guaranty" or similar word may be used by a provider. This section shall not apply to a company that was using any of the prohibited language in its name prior to April 1, 1999. However, a company using the prohibited language in its name shall include in its service contracts a statement in substantially the following form: "This agreement is not an insurance contract."
(b) A provider or its representative shall not in its service contracts or literature make, permit or cause to be made any false or misleading statement, or deliberately omit any material statement that would be considered misleading if omitted.
(c) A person, such as a bank, savings and loan association, lending institution, manufacturer or seller of any product, shall not require the purchase of a service contract as a condition of a loan or a condition for the sale of any property.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 49 - Service Contracts › Section 26-49-107 - Record Keeping Requirements.

26-49-107. Record keeping requirements.
(a) The provider shall keep accurate accounts, books, and records concerning transactions regulated under this article. The provider s accounts, books and records shall include the following:
(i) Copies of each type of service contract sold;
(ii) The name and address of each service contract holder, to the extent that the name and address have been furnished by the service contract holder;
(iii) A list of the locations where service contracts are marketed, sold or offered for sale;
(iv) Written claims files, which shall contain at least the dates and description of claims related to the service contracts.
(b) Except as provided in subsection (d) of this section, the provider shall retain all records required to be maintained by this section for at least one (1) year after the specified period of coverage has expired.
(c) The records required under this article may be, but are not required to be, maintained on a computer disk or other record keeping technology. If the records are maintained in other than hard copy, the records shall be capable of duplication to legible hard copy at the request of the commissioner.
(d) A provider discontinuing business in this state shall maintain its records until it furnishes the commissioner satisfactory proof that it has discharged all obligations to service contract holders in this state.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 49 - Service Contracts › Section 26-49-108 - Cancellation of Reimbursement Insurance Policy.

26-49-108. Cancellation of reimbursement insurance policy.
As applicable, an insurer that issued a reimbursement insurance policy shall not terminate the policy until a notice of termination in accordance with chapter 35 of this code, has been mailed or delivered to the commissioner. The termination of a reimbursement insurance policy shall not reduce the issuer s responsibility for service contracts issued by providers prior to the date of the termination.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 49 - Service Contracts › Section 26-49-109 - Obligations of Reimbursement Insurance Policy Insurers.

26-49-109. Obligations of reimbursement insurance policy insurers.
(a) Providers are considered to be the agent of the insurer which issued the reimbursement insurance policy for purposes of obligating the insurer to service contract holders in accordance with the service contract and this article. In cases where a provider is acting as an administrator and enlists other providers, the provider acting as the administrator shall notify the insurer of the existence and identities of the other providers.
(b) This article shall not prevent or limit the right of an insurer which issued a reimbursement insurance policy to seek indemnification or subrogation against a provider if the issuer pays or is obligated to pay the service contract holder sums that the provider was obligated to pay pursuant to the provisions of the service contract.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 49 - Service Contracts › Section 26-49-110 - Enforcement Provisions.

26-49-110. Enforcement provisions.
(a) The commissioner may conduct examinations of providers, administrators, insurers or other persons to enforce this article and protect service contract holders in this state. Upon request of the commissioner, the provider shall make all accounts, books and records concerning service contracts sold by the provider available to the commissioner which are necessary to enable the commissioner to reasonably determine compliance or noncompliance with this article.
(b) The commissioner may take action which is necessary or appropriate to enforce the provisions of this article and the commissioner s regulations and orders, and to protect service contract holders in this state.
(c) If a provider has violated this article or the commissioner s regulations or orders, the commissioner may issue an order directed to that provider to cease and desist from committing violations of this article or the commissioner s regulations or orders; may issue an order prohibiting that provider from selling or offering for sale service contracts in violation of this article; or may issue an order imposing a civil penalty on that provider; or any combination of the foregoing, as applicable. A person aggrieved by an order issued under this section may request a hearing before the commissioner pursuant to W.S. 26-2-125.
(d) The commissioner may bring an action in any court of competent jurisdiction, for an injunction or other appropriate relief to enjoin threatened or existing violations of this article or of the commissioner s orders or regulations. An action filed under this section also may seek restitution on behalf of persons aggrieved by a violation of this article or orders or regulations of the commissioner.
(e) A person who is found to have violated this article or orders or regulation of the commissioner may be ordered to pay to the commissioner a civil penalty in an amount determined by the commissioner of not more than five hundred dollars ($500.00) per violation and no more than ten thousand dollars ($10,000.00) in the aggregate for all violations of a similar nature. For purposes of this section, violations shall be of a similar nature if the violation consists of the same or similar course of conduct, action or practice, irrespective of the number of times the act, conduct or practice which is determined to be a violation of this article occurred.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 51 - Own Risk Solvency › Section 26-51-102 - Definitions.

26-51-102. Definitions.
(a) As used in this chapter:
(i) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in W.S. 26-44-101(a)(iv);
(ii) "Insurer" shall have the same meaning as set forth in W.S. 26-1-102(a)(xvi), except that it shall not include agencies, authorities or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia or a state or political subdivision of a state;
(iii) "Own risk and solvency assessment" or "ORSA" means a confidential internal assessment, appropriate to the nature, scale and complexity of an insurer or insurance group, conducted by that insurer or insurance group of the material and relevant risks associated with the insurer or insurance group's current business plan, and the sufficiency of capital resources to support those risks;
(iv) "ORSA guidance manual" means the current version of the Own Risk and Solvency Assessment Guidance Manual developed and adopted by the National Association of Insurance Commissioners (NAIC) and as amended from time to time. A change in the ORSA guidance manual shall be effective on January 1 following the calendar year in which the changes have been adopted by the NAIC;
(v) "ORSA summary report" means a confidential high-level summary of an insurer or insurance group's ORSA.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 51 - Own Risk Solvency › Section 26-51-103 - Risk Management Framework.

26-51-103. Risk management framework.
An insurer shall maintain a risk management framework to assist the insurer with identifying, assessing, monitoring, managing and reporting on its material and relevant risks. This requirement may be satisfied if the insurance group of which the insurer is a member maintains a risk management framework applicable to the operations of the insurer.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 51 - Own Risk Solvency › Section 26-51-104 - Orsa Requirement.

26-51-104. ORSA requirement.
Subject to W.S. 26-51-106, an insurer, or the insurance group of which the insurer is a member, shall regularly conduct an ORSA consistent with a process comparable to the ORSA guidance manual. The ORSA shall be conducted no less than annually but also at any time when there are significant changes to the risk profile of the insurer or the insurance group of which the insurer is a member.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 51 - Own Risk Solvency › Section 26-51-105 - Orsa Summary Report.

26-51-105. ORSA summary report.
(a) Upon the commissioner's request, and no more than once each year, an insurer shall submit to the commissioner an ORSA summary report or any combination of reports that together contain the information described in the ORSA guidance manual, applicable to the insurer and the insurance group of which it is a member. Notwithstanding any request from the commissioner, if the insurer is a member of an insurance group, the insurer shall submit the report required by this subsection if the commissioner is the lead state commissioner of the insurance group as determined by the procedures within the financial analysis handbook adopted by the NAIC.
(b) The report shall include a signature of the insurer or insurance group's chief risk officer or other executive having responsibility for the oversight of the insurer's enterprise risk management process attesting to the best of his belief and knowledge that the insurer applies the enterprise risk management process described in the ORSA summary report and that a copy of the report has been provided to the insurer's board of directors or the appropriate committee thereof.
(c) An insurer may comply with subsection (a) of this section by providing the most recent and substantially similar report provided by the insurer or another member of an insurance group of which the insurer is a member to the commissioner of another state or to a supervisor or regulator of a foreign jurisdiction, if that report provides information that is comparable to the information described in the ORSA guidance manual. Any report in a language other than English shall be accompanied by a translation of that report into the English language.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 51 - Own Risk Solvency › Section 26-51-107 - Contents of Orsa Summary Report.

26-51-107. Contents of ORSA summary report.
(a) The ORSA summary report shall be prepared consistent with the ORSA guidance manual, subject to the requirements of subsection (b) of this section. Documentation and supporting information shall be maintained and made available upon examination or upon request of the commissioner.
(b) The review of the ORSA summary report, and any additional requests for information, shall be made using similar procedures currently used in the analysis and examination of multi-state or global insurers and insurance groups.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 51 - Own Risk Solvency › Section 26-51-109 - Sanctions.

26-51-109. Sanctions.
Any insurer failing, without just cause, to timely file the ORSA summary report as required in this chapter shall be required, after notice and hearing, to pay a penalty of two thousand five hundred dollars ($2,500.00) for each day's delay, to be recovered by the commissioner. The maximum penalty under this section is seventy-five thousand dollars ($75,000.00). The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 52 - Pharmacy Benefit Managers › Section 26-52-101 - Licensure of Pharmacy Benefit Managers.

26-52-101. Licensure of pharmacy benefit managers.
No person shall act or hold himself out as a pharmacy benefit manager in this state unless he obtains a license from the department. The department shall through rules establish license requirements and procedures for the licensing of pharmacy benefit managers consistent with this article. The requirements shall only provide for the adequate identification of licensees and the payment of the required licensing fee.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 52 - Pharmacy Benefit Managers › Section 26-52-102 - Definitions.

26-52-102. Definitions.
(a) As used in this article:
(i) "Claim" means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device;
(ii) "Insurer" means the entity defined in W.S. 26-1-102(a)(xvi) and who provides health insurance coverage in this state;
(iii) "List" means the list of drugs for which a pharmacy benefit manager has established a maximum allowable cost;
(iv) "Maximum allowable cost" means the maximum amount that a pharmacy benefit manager will reimburse a pharmacist or pharmacy for the cost of a generic drug;
(v) "Network providers" means those pharmacies that provide covered health care services or supplies to an insured or a member pursuant to a contract with a network plan to act as a participating provider;
(vi) "Pharmacy" means an entity through which pharmacists or other persons practice pharmacy as specified in W.S. 33-24-124;
(vii) "Pharmacy benefit manager" means an entity that contracts with a pharmacy or the pharmacy's designee who holds a contract with the pharmacy benefit manager on behalf of an insurer or third party administrator to administer or manage prescription drug benefits;.
(ix) "Pharmacy services" means any product, good or service, or any combination of products, goods or services, provided as part of the practice of pharmacy;
(x) "Pharmacy services administrative organization" means an organization that evaluates and executes pharmacy benefit manager contracts on behalf of pharmacies and provides administrative, clerical, audit and data analytics support services.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 52 - Pharmacy Benefit Managers › Section 26-52-105 - Transparency; Prohibitions.

26-52-105. Transparency; prohibitions.
(a) A pharmacy benefit manager or an agent of a pharmacy benefit manager shall not:
(i) Cause or knowingly permit the use of an advertisement, promotion, solicitation, representation, proposal or offer that is untrue, deceptive or misleading;
(ii) Charge a pharmacist or pharmacy provider a fee for any of the following:
(A) The submission of a claim;
(B) Enrollment or participation in a retail pharmacy network;
(C) The development or management of claims processing services or claims payment services related to participation in a retail pharmacy network;
(D) An application to apply for network access with the pharmacy benefit manager;
(E) Credentialing or re-credentialing.
(iii) Retroactively deny or reduce reimbursement for a covered pharmacy service or claim after adjudication of the claim, unless:
(A) The original claim was fraudulent; or
(B) The denial or reduction is necessary to correct errors found in an audit, provided that the audit was conducted in compliance with W.S. 26-52-103.
(vii) Prohibit a pharmacy, pharmacy services administrative organization, contracting agent or agent of a pharmacy from sharing, upon request, copies of pharmacy benefit manager contracts with the department of insurance;
(viii) Prohibit, restrict or limit disclosure of information to the insurance commissioner, law enforcement or other state or federal government officials who are investigating or examining a complaint or conducting a review of the pharmacy benefit manager's compliance with the requirements of this chapter.
(c) Insurers, pharmacies and pharmacy benefit managers shall adhere to all state laws and rules when mailing or shipping prescription drugs into the state.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 52 - Pharmacy Benefit Managers › Section 26-52-106 - Alternate Reimbursement Methodologies.

26-52-106. Alternate reimbursement methodologies.
All contracts between a pharmacy benefits manager and a pharmacy services administrative organization, or its contracted pharmacies, and all contracts directly between a pharmacy benefits manager and a pharmacy shall include a process to investigate and resolve disputes.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 52 - Pharmacy Benefit Managers › Section 26-52-107 - Certain Claims Excluded.

26-52-107. Certain claims excluded.
W.S. 26-52-104 through 26-52-106 shall apply to all health benefit plan issuers and pharmacy benefit managers except those claims associated with the Wyoming Medicaid fee-for-service program, the Wyoming workers compensation division or those claims otherwise prohibited by federal law.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 53 - Third Party Administrators › Section 26-53-101 - Definitions.

26-53-101. Definitions.
(a) As used in this chapter:
(i) "Third party administrator" means a person who directly or indirectly underwrites, collects charges, collateral or premiums from, or adjusts or settles claims on residents of this state, in connection with life, annuity, health, or stop-loss coverage offered or provided by an insurer, but does not include any of the following:
(A) An employer on behalf of its employees or the employees of one (1) or more subsidiary or affiliated corporations of such employer;
(B) A union on behalf of its members;
(C) A fully self-funded insurance plan meeting the definition of employee benefit plan as set forth in the Employee Retirement Income Security Act of 1974;
(D) An insurance company licensed in this state;
(E) A prepaid hospital or medical care plan;
(F) An insurance agent or broker licensed in this state when acting as an insurance agent or broker;
(G) A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors;
(H) A bank, credit union or other financial institution which is subject to supervision or examination by federal or state banking authorities when acting as a bank, credit union or other financial institution and not as an administrator;
(J) A credit card company which advances for and collects premiums or charges from its credit card holders who have authorized it to do so, provided such company does not adjust or settle claims;
(K) A person who adjusts or settles claims in the normal course of the person's practice or employment as an attorney at law or an adjuster licensed in this state and who does not collect charges or premiums in connection with insurance coverage or annuities.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 53 - Third Party Administrators › Section 26-53-102 - Registration of Third Party Administrators; Rulemaking Authority.

26-53-102. Registration of third party administrators; rulemaking authority.
No person shall act as a third party administrator in this state without a certificate of registration issued by the commissioner. The commissioner in compliance with the Wyoming Administrative Procedure Act shall promulgate reasonable rules and regulations necessary to implement this chapter.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 54 - Corporate Governance Annual Disclosure › Section 26-54-101 - Short Title; Applicability.

26-54-101. Short title; applicability.
(a) This chapter is known and may be cited as the Wyoming Insurance Corporate Governance Annual Disclosure Act.
(b) The requirements of this act shall apply to all insurers and insurance groups domiciled in this state.
(c) Nothing in this act shall be construed to prescribe or impose corporate governance standards and internal procedures beyond that which is required under the corporate law of this state.
(d) Nothing in this act shall be construed to limit the commissioner's authority, or the rights or obligations of third parties, pursuant to the Wyoming Insurance Code.
(e) No insurer or insurance group shall be required to file the disclosure required by this act until 2020.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 54 - Corporate Governance Annual Disclosure › Section 26-54-102 - Definitions.

26-54-102. Definitions.
(a) As used in this act:
(i) "Corporate governance" means the system of rules, practices and procedures by which a corporation is managed by its directors and officers;
(ii) "Corporate governance annual disclosure" or "CGAD" means a confidential report filed by an insurer or insurance group in accordance with the requirements of this act;
(iii) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined under W.S. 26-44-101(a)(iv);
(iv) "Insurer" shall have the same meaning as set forth under W.S. 26-1-102(a)(xvi) and include domestic fraternal benefit societies and health maintenance organizations. This term shall not include agencies, authorities or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 54 - Corporate Governance Annual Disclosure › Section 26-54-104 - Rules and Regulations.

26-54-104. Rules and regulations.
The commissioner shall promulgate rules and regulations necessary to carry out the provisions of this act. The rules and regulations shall be consistent with this act and the commissioner shall be guided by the model regulations adopted by the National Association of Insurance Commissioners at its 2014 fall national meeting and subsequent provisions of those model regulations, provided the model regulations are consistent with this act and other relevant provisions of Wyoming law and are not inappropriate for Wyoming circumstances.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 54 - Corporate Governance Annual Disclosure › Section 26-54-105 - Contents of Corporate Governance Annual Disclosure.

26-54-105. Contents of corporate governance annual disclosure.
(a) An insurer or insurance group shall have discretion over the manner in which a CGAD is submitted, provided the CGAD shall contain the material information necessary to permit the commissioner to gain an understanding of the insurer's or insurance group's corporate governance structure, policies and practices. The commissioner may request additional information deemed material and necessary to provide the commissioner with a clear understanding of corporate governance policies and the reporting, information systems or controls used to implement those policies.
(b) Notwithstanding subsection (a) of this section, the CGAD shall be prepared consistent with this subsection and corporate governance annual disclosure regulations adopted pursuant to W.S. 26-54-104. The CGAD shall describe:
(i) The insurer's or insurance group's corporate governance framework;
(ii) The policies and practices of the most senior governing entity and significant committees thereof;
(iii) Policies and practices for directing senior management; and
(iv) The processes by which the board and senior management ensure an appropriate amount of oversight to the critical risk areas impacting the insurer s business activities.
(c) Documentation and supporting information relevant to the CGAD shall be maintained and made available for examination or upon request of the commissioner.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 54 - Corporate Governance Annual Disclosure › Section 26-54-108 - Sanctions.

26-54-108. Sanctions.
Any insurer failing, without just cause, to timely file the CGAD required by this act shall be required, after notice and hearing, to pay a penalty of one hundred dollars ($100.00) for each day that the CGAD is not filed, to be recovered by the commissioner. The maximum penalty due under this section shall be five thousand dollars ($5,000.00). The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.
2023 Wyoming Statutes › Title 27 - Labor and Employment › Chapter 1 - General Provisions › Section 27-1-101 - "Manufacturing Establishment" Defined; "Person" Defined.

27-1-101. "Manufacturing establishment" defined; "person" defined.
Manufacturing establishments, as those words are used in this act, shall mean and include all smelters, oil refineries, cement works, mills of every kind, machine and repair shops, and in addition to the foregoing, any other kind or character of manufacturing establishment, of any nature or description whatsoever, wherein any natural product or other articles or materials of any kind, in a raw or unfinished or incomplete state or condition, are converted into a new or improved or different form. Wherever the expression occurs in this act in substantially the following words: "every person owning or operating any manufacturing establishment," or where language similar to that is used, the word "person" in that connection shall be held and construed to mean any person or persons, partnership, corporation, receiver, trust, trustee, or any other person or combination of persons, either natural or artificial, by whatever name he or they may be called.
2023 Wyoming Statutes › Title 27 - Labor and Employment › Chapter 1 - General Provisions › Section 27-1-102 - Doors at Public Places to Open Outward; Handrails on Stairs; Enforcement.

27-1-102. Doors at public places to open outward; handrails on stairs; enforcement.
All doors leading into or to any manufacturing establishment, mills, workshops, offices, bakeries, laundries, stores, hotels, theaters, halls, or other buildings in which people are employed, shall be so constructed as to open outward, when practicable, and shall not be locked, bolted or fastened so as to prevent free egress during working hours. Proper and substantial handrails shall be provided on all stairways in manufacturing establishments, mills, workshops, offices, bakeries, laundries, stores, hotels, theaters, halls, and other buildings where people are employed or rooms are rented to the public. The department of workforce services shall have authority to enforce by due process of law, the provisions of this section, and other laws relating to fire escapes.
2023 Wyoming Statutes › Title 27 - Labor and Employment › Chapter 1 - General Provisions › Section 27-1-103 - Safety Devices on Elevators and Machinery.

27-1-103. Safety devices on elevators and machinery.
The openings of all hoistways, hatchways, elevators, well holes and stairways in manufacturing establishments, mills, workshops, bakeries, laundries, stores, hotels, theaters, halls, or any other kind of establishment where labor is employed, or machinery used, shall be protected by trapdoors, hatches, fences, automatic gates or other safeguards, and all due diligence shall be used to keep all such means of protection closed, except when it is necessary to have the same open for use when practicable. All machinery, in use in any mercantile, manufacturing, or any other establishment whatsoever where labor is employed, shall be equipped, with proper shifters for throwing on or off pulleys, loose pulleys and other such safeguards as may be deemed necessary by the department of workforce services for the proper safeguard of life and limb.
2023 Wyoming Statutes › Title 27 - Labor and Employment › Chapter 1 - General Provisions › Section 27-1-104 - Mines and Interstate Railroads Exempt.

27-1-104. Mines and interstate railroads exempt.
Nothing herein contained, as applied to inspection and application of safety devices, shall be construed to be applicable to coal and metalliferous mines and workshops connected therewith, nor to railroads engaged in interstate commerce and workshops connected therewith.
2023 Wyoming Statutes › Title 27 - Labor and Employment › Chapter 1 - General Provisions › Section 27-1-105 - Employees' Contract Releasing Employer From Personal Injury Liability Void.

27-1-105. Employees' contract releasing employer from personal injury liability void.
It shall be unlawful for any person, company or corporation to require of its servants or employees, as a condition of their employment or otherwise, any contract or agreement whereby such person, company or corporation shall be released or discharged from liability or responsibility on account of personal injuries received by such servants or employees while in service of such person, company or corporation, by reason of the negligence of such person, company or corporation, or the agents or employees thereof, and such contracts shall be absolutely null and void.