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2023 West Virginia Code › Chapter 33. Insurance › Article 25D. Prepaid Limited Health Service Organization Act › §33-25D-22. Rules

The commissioner may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code:
(1) To effectuate the purposes of this article and to prevent circumvention and evasion thereof; and
(2) To define the commissioner's authority to consider the operating results of a prepaid limited health service organization's affiliates and subsidiaries in the rate making and solvency determination of that prepaid limited health service organization.
2023 West Virginia Code › Chapter 33. Insurance › Article 25D. Prepaid Limited Health Service Organization Act › §33-25D-23. Administrative Procedures

(a) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, he or she shall notify the prepaid limited health service organization in writing specifically stating the grounds for denial, suspension or revocation and fixing a time of at least twenty days thereafter for a hearing on the matter.
(b) After the hearing, or upon the failure of the prepaid limited health service organization to appear at the hearing, the commissioner shall take action as is considered advisable on written findings which shall be mailed to the prepaid limited health service organization. The action of the commissioner is subject to review. The court may modify, affirm or reverse the order of the commissioner, in whole or in part.
(c) Proceedings under this article are governed by the provisions of section thirteen, article two of this chapter.
2023 West Virginia Code › Chapter 33. Insurance › Article 25D. Prepaid Limited Health Service Organization Act › §33-25D-24. Fees

Every prepaid limited health service organization subject to this article shall pay to the commissioner the following fees:
(1) For filing an application for a certificate of authority or amendment thereto, $200;
(2) For each renewal of a certificate of authority, the annual fee as provided in section thirteen, article three of this chapter;
(3) For each form filing and for each rate filing, the fee as provided in section thirty-four, article six of this chapter; and
(4) For filing each annual report, $25.
Fees charged under this section are for the purposes set forth in section thirteen, article three of this chapter.
2023 West Virginia Code › Chapter 33. Insurance › Article 25D. Prepaid Limited Health Service Organization Act › §33-25D-27. Filings and Reports as Public Documents

All applications, filings and reports required under this article are public documents: Provided, That where the provisions of other articles in this chapter are applicable to prepaid limited health service organizations, all applications, filings and reports required under those articles shall be afforded the level of confidentiality as provided in those articles.
2023 West Virginia Code › Chapter 33. Insurance › Article 25D. Prepaid Limited Health Service Organization Act › §33-25D-29. Authority to Contract With Prepaid Limited Health Service Organizations Under Medicaid

The Department of Health and Human Resources is authorized to enter into contracts with prepaid limited health service organizations certified and permitted to market under the laws of this state, and to furnish to recipients of medical assistance under Title XIX of the Social Security Act, 42 U.S.C. §1396, et seq., limited health services offered to such recipients under the medical assistance plan of West Virginia. The children's health policy board, the Department of Health and Human Resources, and the Division of Juvenile Services within the Department of Military Affairs and Public Safety are further authorized to enter into contracts with prepaid limited health service organizations to furnish behavioral health services to adults and children who are eligible to receive such services under chapter five, chapter sixteen, chapter twenty-seven or chapter forty-nine of this code.
2023 West Virginia Code › Chapter 33. Insurance › Article 25D. Prepaid Limited Health Service Organization Act › §33-25D-30. Authority of Commissioner to Propose Rules Regarding Affiliate and Subsidiary Operating Results

The commissioner may after notice and hearing propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to define the commissioner's authority to consider the operating results of an insurer's affiliates and subsidiaries in the rate making and solvency determination of that insurer.
2023 West Virginia Code › Chapter 33. Insurance › Article 25E. Patients' Eye Care Act › §33-25E-3. Limitations on Conditions of Coverage

(a)Health benefits policies may not require that an optometrist hold hospital staff privileges.
(b)When any health benefits policy provides for the payment of eye care benefits or vision care benefits, such policy shall be construed to include payment to all eye care providers who provide benefits within the scope of their providers' licenses.
(c)Any limitation or condition placed upon services, diagnosis or treatment by or payment to a particular type of licensed provider shall apply equally to all licensed providers without unfair discrimination as to the usual and customary treatment procedures of an eye care provider.
(d)Any health benefits policy that includes eye care benefits, including a diabetic retinal examination, shall provide each covered person diagnosed with diabetes direct access to an eye care provider of their choice from the insurer's panel of providers independent of, and without referral from, any other provider or entity for one annual diabetic retinal examination. The eye care provider shall provide copies of the results of the examination to the covered person's primary care physician. No other services shall be provided to the covered person by the eye care provider without the prior authorization of the insurer or of its designee. This benefit shall be subject to all coinsurance, deductibles, copayments and other policy requirements. When the diabetic retinal examination reveals the beginning stages of an abnormal condition, access to future examinations shall be subject to prior authorization from a primary care physician.
(e)Any health benefits policy that includes eye care benefits or vision care benefits shall include both optometrists and ophthalmologists.
(f)This article may not be construed to require any health benefits policy to cover any specific health care service.
(g)This article may not be construed to require a health benefit plan or an insurer to include on the insurer's panel of providers all providers willing to meet the terms and conditions of participation as a plan provider.
2023 West Virginia Code › Chapter 33. Insurance › Article 25E. Patients' Eye Care Act › §33-25E-4. Required Disclosure

Every health benefits policy that is issued, delivered, issued for redelivery or renewed in this state on or after January 1, 2001, that provides for eye care benefits, including a diabetic retinal examination, shall disclose in writing, in clear and accurate language, to enrollees, subscribers, providers and insureds that any covered person diagnosed with diabetes has the right to direct access to an eye care provider of their choice from the insurer's panel of providers for an annual diabetic retinal examination.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-2. Purpose

The purpose of this article is to provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to the extent provided in this article, minimize financial loss to claimants or policyholders because of the insolvency of an insurer, and to permit and to provide an association to assess the cost of this protection among insurers.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-3. Scope

This article applies to all kinds of direct insurance, but is not applicable to the following:
(1) Life, annuity, health or disability insurance;
(2) Mortgage guaranty, financial guaranty or other forms of insurance offering protection against investment risks;
(3) Fidelity or surety bonds, or any other bonding obligations;
(4) Credit insurance, vendors’ single interest insurance or collateral protection insurance or any similar insurance protecting the interests of a creditor arising out of a creditor-debtor transaction;
(5) Insurance of warranties or service contracts including insurance that provides for the repair, replacement or service of goods or property, indemnification for repair, replacement or service for the operational or structural failure of the goods or property due to a defect in materials, workmanship or normal wear and tear, or provides reimbursement for the liability incurred by the issuer of agreements or service contracts that provide such benefits;
(6) Title insurance;
(7) Ocean marine insurance;
(8) Any transaction or combination of transactions between a person, including affiliates of such person, and an insurer, including affiliates of the insurer, which involves the transfer of investment or credit risk unaccompanied by transfer of insurance risk; or
(9) Any insurance provided by or guaranteed by a government entity or agency.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-6. Creation of the Association

There is created a nonprofit unincorporated legal entity to be known as the West Virginia Insurance Guaranty Association. All insurers defined as member insurers in section five of this article shall be and remain members of the association as a condition of their authority to transact insurance in this state. The association shall perform its functions under a plan of operation established and approved under section nine of this article and shall exercise its powers through a board of directors established under section seven of this article. For purposes of administration and assessment, the association shall establish and maintain three separate accounts:
(1) The automobile insurance account;
(2) The workers' compensation insurance account; and
(3) The account for all other insurance to which this article applies.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-7. Board of Directors

(1) The board of directors of the association shall consist of not less than five nor more than nine persons serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the commissioner. Vacancies on the board shall be filled for the remaining period of the term in the same manner as initial appointments. If no members are selected within sixty days after the effective date of this article, the commissioner may appoint the initial members of the board of directors.
(2) In approving selections to the board, the commissioner shall consider among other things whether all member insurers are fairly represented.
(3) Members of the board may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-9. Plan of Operation

(a) The association shall:
(1) Submit to the commissioner a plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the association. The plan of operation and any amendments thereto become effective upon approval in writing by the commissioner.
(2) If the association fails to submit a suitable plan of operation within ninety days following the effective date of this article or if at any time thereafter the association fails to submit suitable amendments to the plan, the commissioner shall, after notice and hearing, adopt rules for legislative approval as are necessary or advisable to effectuate the provisions of this article. The rules shall continue in force until modified by the commissioner or superseded by a plan submitted by the association and approved by the commissioner. All such rules shall be proposed in accordance with chapter twenty-nine-a of this code.
(b) All member insurers shall comply with the plan of operation.
(c) The plan of operation shall:
(1) Establish the procedures whereby all the powers and duties of the association under section eight of this article will be performed.
(2) Establish procedures for handling assets of the association.
(3) Establish the amount and method of reimbursing members of the board of directors under section seven of this article.
(4) Establish procedures by which claims may be filed with the association and establish acceptable forms of proof of covered claims.
(5) Establish regular places and times for meetings of the board of directors.
(6) Establish procedures for records to be kept of all financial transactions of the association, its agents and the board of directors.
(7) Provide that any member insurer aggrieved by a final action or decision of the association may appeal to the commissioner within thirty days after the action or decision.
(8) Establish the procedures whereby selections for the board of directors will be submitted to the commissioner.
(9) Contain additional provisions necessary or proper for the execution of the powers and duties of the association.
(d) The plan of operation may provide that any or all powers and duties of the association, except those under subdivision (3), subsection (a), and subdivision (2), subsection (b), section eight of this article are delegated to a corporation, association or other organization which performs or will perform functions similar to those of this association, or its equivalent, in two or more states. Such a corporation, association or organization shall be reimbursed as a servicing facility would be reimbursed and shall be paid for its performance of any other functions of the association. A delegation under this subsection may take effect only with the approval of both the board of directors and the commissioner, and may be made only to a corporation, association or organization which extends protection not substantially less favorable and effective than that provided by this article.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-10. Duties and Powers of the Commissioner

(a) The commissioner shall:
(1) Notify the association of the existence of an insolvent insurer not later than three business days after he or she receives notice of the determination of the insolvency.
(2) Upon request of the board of directors, provide the association a statement of the net direct written premiums of each member insurer.
(b) The commissioner may:
(1) Require that the association notify the insureds of the insolvent insurer and any other interested parties of the determination of insolvency and of their rights under this article. The notification shall be by mail at their last known address, where available, but if sufficient information for notification by mail is not available, notice by publication in a newspaper of general circulation is sufficient.
(2) Suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer which fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative, the commissioner may levy a fine on any member insurer which fails to pay an assessment when due. The fine may not exceed five percent of the unpaid assessment per month, except that no fine may be less than $100 per month.
(3) Revoke the designation of any servicing facility if he or she finds that claims are being handled unsatisfactorily.
(c) Any final order of the commissioner under this article is subject to judicial review as provided by section fourteen, article two of this chapter.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-13. Prevention of Insolvencies

To aid in the detection and prevention of insurer insolvencies:
(1) The board of directors may, upon majority vote, make recommendations to the commissioner on matters generally related to improving or enhancing regulation for solvency.
(2) At the conclusion of any domestic insurer insolvency in which the association was obligated to pay covered claims, the board of directors may, upon majority vote, prepare a report on the history and causes of the insolvency, based on the information available to the association and submit the report to the commissioner.
(3) Reports and recommendations provided under this section may not be considered public documents subject to disclosure under chapter twenty-nine-b of this code.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-16. Recognition of Assessments in Rates

The rates and premiums charged for insurance policies to which this article applies shall include amounts sufficient to recoup a sum equal to the amounts paid to the association by the member insurer less any amounts returned to the member insurer by the association and such rates shall not be deemed excessive because they contain an amount reasonably calculated to recoup assessments paid by the member insurer.
2023 West Virginia Code › Chapter 33. Insurance › Article 26. West Virginia Guaranty Association Act › §33-26-18. Stay of Proceedings; Reopening of Default Judgments

(a) All proceedings in which the insolvent insurer is a party or obligated to defend a party in any court in this state shall, subject to waiver by the association in specific cases involving covered claims, be stayed for six months and such additional time as may be determined by the court from the date the insolvency is determined to permit proper defense by the association of all pending causes of action.
(b) The liquidator, receiver or statutory successor of an insolvent insurer covered by this article shall permit access by the association, or its authorized representative to such of the insolvent insurer’s records that are necessary for the association in carrying out its functions under this article with regard to covered claims. In addition, the liquidator, receiver or statutory successor shall provide the association or its representative with copies of such records upon the request by the association and at the expense of the association.
(c) As to any covered claims arising from a judgment under any order, decision, verdict or finding based on the default of the insolvent insurer or its wrongful failure to defend an insured, the association either on its own behalf or on behalf of such insured may apply to have such judgment, order, decision, verdict or finding set aside by the same court or administrator that made such judgment, order, decision, verdict or finding and shall be permitted to defend against such claim on the merits.
2023 West Virginia Code › Chapter 33. Insurance › Article 26A. West Virginia Life and Health Insurance Guaranty Association Act › §33-26A-2. Purpose of Article and Association of Insurers

(a) The purpose of this article is to protect, subject to certain limitations, the persons specified in §33-26A-3(a) of this code against failure in the performance of contractual obligations, under life, health, and annuity policies, plans, or contracts specified in §33-26A-3(b) of this code, because of the impairment or insolvency of the member insurer that issued the policies, plans, or contracts.
(b) To provide this protection, an association of member insurers is created to pay benefits and to continue coverages as limited by this article, and members of the association are subject to assessment to provide funds to carry out the purpose of this article.
2023 West Virginia Code › Chapter 33. Insurance › Article 26A. West Virginia Life and Health Insurance Guaranty Association Act › §33-26A-6. Creation of Association; Required Accounts; Supervision of Commissioner; Meetings and Records

(a) There is created a nonprofit legal entity to be known as the West Virginia Life and Health Insurance Guaranty Association. All member insurers shall be and remain members of the association as a condition of their authority to transact insurance or a health maintenance organization business in this state. The association shall perform its functions under the plan of operation established and approved under §33-26A-10 of this code and shall exercise its powers through a board of directors established under §33-26A-7 of this code. For purposes of administration and assessment, the association shall maintain the following two accounts:
(1) The life insurance and annuity account which includes the following subaccounts:
(A) Life insurance account;
(B) Annuity account which shall include annuity contracts owned by a governmental retirement plan or its trustee established under section 401, 403(b), or 457 of the United States Internal Revenue Code, but shall otherwise exclude unallocated annuities; and
(C) Unallocated annuity account which shall exclude contracts owned by a governmental retirement plan or its trustee established under section 401, 403(b), or 457 of the United States Internal Revenue Code.
(2) The health account.
(b) The association shall come under the immediate supervision of the commissioner and shall be subject to the applicable provisions of the insurance laws of this state. Meetings or records of the association may be opened to the public upon majority vote of the board of directors of the association.
2023 West Virginia Code › Chapter 33. Insurance › Article 26A. West Virginia Life and Health Insurance Guaranty Association Act › §33-26A-7. Board of Directors; Members; Vacancies; Voting Rights; Appointment and Reimbursement

(a) The board of directors of the association shall consist of not less than seven nor more than 11 member insurers serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the commissioner. Vacancies on the board shall be filled for the remaining period of the term by a majority vote of the remaining board members, subject to the approval of the commissioner.
(b) To select the initial board of directors, and initially organize the association, the commissioner shall give notice to all member insurers of the time and place of the organizational meeting. In determining voting rights at the organizational meeting, each member insurer shall be entitled to one vote in person or by proxy. If the board of directors is not selected within 60 days after notice of the organizational meeting, the commissioner may appoint the initial members.
(c) In approving selections or in appointing members to the board, the commissioner shall consider, among other things, whether all member insurers are fairly represented.
(d) Members of the board may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors but members of the board shall not otherwise be compensated by the association for their services.
2023 West Virginia Code › Chapter 33. Insurance › Article 26A. West Virginia Life and Health Insurance Guaranty Association Act › §33-26A-11. Duties and Powers of Commissioner of Insurance

In addition to the duties and powers enumerated elsewhere in this article:
(a) The commissioner shall:
(1) Upon request of the board of directors, provide the association with a statement of the premiums in this and any other appropriate states for each member insurer;
(2) When an impairment is declared and the amount of the impairment is determined, serve a demand upon the impaired insurer to make good the impairment within a reasonable time. Notice to the impaired insurer shall constitute notice to its shareholders, if any; the failure of the impaired insurer to promptly comply with the demand shall not excuse the association from the performance of its powers and duties under this article; and
(3) In any liquidation or rehabilitation proceeding involving a domestic insurer, be appointed as the liquidator or rehabilitator.
(b) The commissioner may suspend or revoke, after notice and hearing, the certificate of authority to transact business in this state of any member insurer which fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative, the commissioner may levy a forfeiture on any member insurer which fails to pay an assessment when due. The forfeiture shall not exceed five percent of the unpaid assessment per month, but no forfeiture shall be less than $100 per month.
(c) A final action of the board of directors or the association may be appealed to the commissioner by any member insurer if such appeal is taken within 60 days of its receipt of notice of the final action being appealed. If a member company is appealing an assessment, the amount assessed shall be paid to the association and available to meet association obligations during the pendency of an appeal. If the appeal on the assessment is upheld, the amount paid in error or excess shall be returned to the member company. Any final action or order of the commissioner shall be subject to judicial review in a court of competent jurisdiction.
(d) The liquidator, rehabilitator, or conservator of any impaired insurer may notify all interested persons of the effect of this article.
2023 West Virginia Code › Chapter 33. Insurance › Article 26A. West Virginia Life and Health Insurance Guaranty Association Act › §33-26A-15. Examination of Association; Annual Report

The association shall be subject to examination and regulation by the commissioner. The board of directors shall submit to the commissioner, not later than May 1 of each year, a financial report for the preceding calendar year in a form approved by the commissioner and a report of its activities during the preceding calendar year.
2023 West Virginia Code › Chapter 33. Insurance › Article 26A. West Virginia Life and Health Insurance Guaranty Association Act › §33-26A-17. Immunity

There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer or its agents or employees, the association or its agents or employees, members of the board of directors, or the commissioner or his or her representatives, for any action or omission by them in the performance of their powers and duties under this article. Such immunity shall extend to the participation in any organization of one or more other state associations of similar purposes and to any such organization and its agents or employees.
2023 West Virginia Code › Chapter 33. Insurance › Article 26A. West Virginia Life and Health Insurance Guaranty Association Act › §33-26A-18. Stay of Court Proceedings; Reopening Default Judgments

All proceedings in which the impaired or insolvent insurer is a party in any court in this state shall be stayed one hundred eighty days from the date an order of liquidation, rehabilitation or conservation is final to permit proper legal action by the association on any matters germane to its powers or duties. As to a judgment under any decision, order, verdict or finding based on default the association may apply to have the judgment set aside by the same court that made the judgment and shall be permitted to defend against the suit on the merits.
2023 West Virginia Code › Chapter 33. Insurance › Article 27. Insurance Holding Company Systems › §33-27-6a. Supervisory Colleges; Power of Commissioner; Expenses; Agreements

(a) Power of Commissioner. –- With respect to any insurer registered under section four of this article, and in accordance with subsection (c) of this section, the commissioner may participate in a supervisory college for any domestic insurer that is part of an insurance holding company system with international operations in order to determine compliance by the insurer with this chapter. The powers of the commissioner with respect to supervisory colleges include, but are not limited to, the following:
(1) Initiating the establishment of a supervisory college;
(2) Clarifying the membership and participation of other supervisors in the supervisory college;
(3) Clarifying the functions of the supervisory college and the role of other regulators, including the establishment of a group-wide supervisor;
(4) Coordinating the ongoing activities of the supervisory college, including planning meetings, supervisory activities, and processes for information sharing; and
(5) Establishing a crisis management plan.
(b) Supervisory College. –- In order to assess the business strategy, financial position, legal and regulatory position, risk exposure, risk management and governance processes, and as part of the examination of individual insurers in accordance with section six of this article, the commissioner may participate in a supervisory college with other regulators charged with supervision of the insurer or its affiliates, including other state, federal and international regulatory agencies. The commissioner may enter into agreements in accordance with subsection (c), section seven of this article providing the basis for cooperation between the commissioner and the other regulatory agencies, and the activities of the supervisory college: Provided, That this section may not be construed as delegating to the supervisory college the authority of the commissioner to regulate or supervise the insurer or its affiliates within its jurisdiction.
2023 West Virginia Code › Chapter 33. Insurance › Article 27. Insurance Holding Company Systems › §33-27-8. Injunctions; Prohibitions Against Voting Securities; Sequestration of Voting Securities

(a) Injunctions. -- Whenever it appears to the commissioner that any person or any director, officer, employee or agent thereof has committed or is about to commit a violation of this article or of any rule, regulation or order issued by the commissioner hereunder, the commissioner may apply to the circuit court for an order enjoining such person or such director, officer, employee or agent thereof from violating or continuing to violate this chapter or any such rule, regulation or order, and for such other equitable relief as the nature of the case and the interests of the insurer's policyholders, creditors and shareholders or the public may require.
(b) Voting of securities: when prohibited. -- No security which is the subject of any agreement or arrangement regarding acquisition, or which is acquired or to be acquired, in contravention of the provisions of this article or of any rule, regulation or order issued by the commissioner hereunder may be voted at any shareholders' meeting, or may be counted for quorum purposes, and any action of shareholders requiring the affirmative vote of a percentage of shares may be taken as though such securities were not issued and outstanding; but no action taken at any such meeting shall be invalidated by the voting of such securities, unless the action would materially affect control of the insurer or unless the courts of this state have so ordered. If an insurer or the commissioner has reason to believe that any security of the insurer has been or is about to be acquired in contravention of the provisions of this article or of any rule, regulation or order issued by the commissioner hereunder the insurer or the commissioner may apply to the circuit court to enjoin any offer, request, invitation, agreement or acquisition made in contravention of section four of this article, or any rule, regulation or order issued by the commissioner thereunder to enjoin the voting of any security so acquired, to void any vote of such security already cast at any meeting of shareholders, and for such other equitable relief as the nature of the case and the interests of the insurer's policyholders, creditors and shareholders or the public may require.
(c) Sequestration of voting securities. -- In any case where a person has acquired or is proposing to acquire any voting securities in violation of this article or any rule, regulation or order issued by the commissioner hereunder, the circuit court may, on such notice as the court deems appropriate, upon the application of the insurer or the commissioner seize or sequester any voting securities of the insurer owned directly or indirectly by such person, and issue such orders with respect thereto as may be appropriate to effectuate the provisions of this article. Notwithstanding any other provisions of law, for the purposes of this article, the situs of the ownership of the securities of domestic insurers shall be deemed to be in this state.
2023 West Virginia Code › Chapter 33. Insurance › Article 27. Insurance Holding Company Systems › §33-27-10. Receivership

Whenever it appears to the commissioner that any person has committed a violation of this article which so impairs the financial condition of a domestic insurer as to threaten insolvency or make the further transaction of business by it hazardous to its policyholders, creditors, shareholders or the public, then the commissioner may take possession of the property of such domestic insurer and proceed as provided in article ten of this chapter.
2023 West Virginia Code › Chapter 33. Insurance › Article 27. Insurance Holding Company Systems › §33-27-11. Revocation, Suspension or Nonrenewal of Insurer's License

Whenever it appears to the commissioner that any person has committed a violation of this article which makes the continued operation of an insurer contrary to the interests of policyholders or the public, the commissioner may, after giving notice and an opportunity to be heard, determine to suspend, revoke or refuse to renew such insurer's license or authority to do business in this state for such period as he or she finds is required for the protection of policyholders or the public: Provided, That any such determination shall be accompanied by specific findings of fact and conclusions of law.
2023 West Virginia Code › Chapter 33. Insurance › Article 27. Insurance Holding Company Systems › §33-27-13. Recovery

(a) If an order for liquidation or rehabilitation of a domestic insurer has been entered, the receiver appointed under such order shall have a right to recover on behalf of the insurer, (1) from any parent corporation or holding company or person or affiliate who otherwise controlled the insurer, the amount of distributions (other than distributions of shares of the same class of stock) paid by the insurer on its capital stock, or (2) any payment in the form of a bonus, termination settlement or extraordinary lump sum salary adjustment made by the insurer or its subsidiary or subsidiaries to a director, officer or employee, when the distribution or payment pursuant to (1) or (2) is made at any time during the one year preceding the petition for liquidation, conservation or rehabilitation, as the case may be, subject to the limitations of subsections (b), (c) and (d) of this section.
(b) No such distribution may be recoverable if the parent corporation or affiliate shows that when paid such distribution was lawful and reasonable, and that the insurer did not know and could not reasonably have known that such distribution might adversely affect the ability of the insurer to fulfill its contractual obligations.
(c) Any person who was a parent corporation or holding company or a person who otherwise controlled the insurer or affiliate at the time such distributions were paid shall be liable up to the amount of distributions or payments under subsection (a) of this section that such person received. Any person who otherwise controlled the insurer at the time such distributions were declared is liable up to the amount of distributions he or she would have received if they had been paid immediately. If two or more persons are liable with respect to the same distributions, they shall be jointly and severally liable.
(d) The maximum amount recoverable under this subsection shall be the amount needed in excess of all other available assets of the impaired or insolvent insurer to pay the contractual obligations of the impaired or insolvent insurer and to reimburse any guaranty funds.
(e) To the extent that any person liable under subsection (c) of this section is insolvent or otherwise fails to pay claims due from it pursuant to subsection (c), its parent corporation or holding company or person who otherwise controlled it at the time the distribution was paid, shall be jointly and severally liable for any resulting deficiency in the amount recovered from such parent corporation or holding company or person who otherwise controlled it.
2023 West Virginia Code › Chapter 33. Insurance › Article 27A. West Virginia Mutual to Mutual Insurance Holding Company Act › §33-27A-2. Definitions

As used in this article:
"Intermediate holding company" means a stock corporation that owns all of the shares of voting stock of one or more recognized stock companies after a reorganization pursuant to this article. "Intermediate holding company" also means a stock company that is the parent or subsidiary of another intermediate holding company.
"Mutual insurance company" means a domestic or foreign mutual Insurance company. "Mutual insurance holding company" means a domestic mutual insurance holding company incorporated pursuant to a reorganization plan adopted pursuant to this article, which company is the parent company of a reorganized stock company or of an intermediate holding company.
"Policyholder" means the person, group of persons, association, corporation, partnership, member or other entity named as the insured under a mutual policy of insurance.
"Reorganization plan" means a reorganization plan adopted by a mutual insurance companys board of directors in accordance with the provisions of this article.
"Reorganized stock company" means the domestic or foreign stock insurance company resulting from a domestic or foreign mutual insurance companys reorganization under this article.
"Voting Stock" means securities of any class or any ownership interests having voting power for the election of directors, trustees, or management of a person, other than securities having voting power only as a result of the occurrence of a contingency.
2023 West Virginia Code › Chapter 33. Insurance › Article 27A. West Virginia Mutual to Mutual Insurance Holding Company Act › §33-27A-6. Amending Articles of Incorporation of Mutual Holding Company

Proposed amendments to the articles of incorporation of a mutual insurance holding company may be adopted at any members meeting. The board of directors of a mutual insurance holding company shall provide notice of any members meeting conducting a vote on the adoption of the amendment to the articles of incorporation by publication in a newspaper of general circulation, published in the county where the companys principle place of business is located, at least 30 days prior to the members meeting. Where the amendment is not inconsistent with the Constitution and laws of the State of West Virginia and of the United States, the amendment may be adopted by the affirmative vote of at least three-fifths of the members present and voting at the meeting.
2023 West Virginia Code › Chapter 33. Insurance › Article 27A. West Virginia Mutual to Mutual Insurance Holding Company Act › §33-27A-7. Corporate Existence of Mutual Company Continue in Recognized Stock Company

(a) Upon a reorganization plan taking effect in accordance with this article, the corporate existence of the mutual insurance company shall continue in the reorganized stock company. On the effective date of the reorganization, all of the assets, rights, franchises and interests of the mutual insurance company in and to every species of property whether real, personal, or mixed and in any accompanying causes of action shall be vested in the reorganized stock company without any deed or transfer, and a reorganized stock company shall assume all of the obligations and liabilities of the mutual insurance company.
(b) Unless otherwise specified in a reorganization plan, those persons who are the directors and officers of a mutual insurance company on the effective date of the reorganization shall serve as the directors and officers of the reorganized stock company until new directors and officers are elected pursuant to the recognized stock companys articles of incorporation.
2023 West Virginia Code › Chapter 33. Insurance › Article 27A. West Virginia Mutual to Mutual Insurance Holding Company Act › §33-27A-9. Reorganization of Mutual Company

(a) A mutual insurance company may reorganize by merging its policyholders members interests into a domestic or foreign mutual insurance holding company and continuing the corporate existence of the mutual insurance company as a reorganized stock company. A mutual company reorganizing under this article shall comply with all applicable laws of this state and of foreign jurisdictions, to affect the reorganization.
(b) A domestic or foreign mutual insurance holding company may reorganize by merging or consolidating its membership interests into another domestic or foreign mutual insurance holding company. A domestic or foreign mutual insurance holding company reorganizing under this subdivision shall comply with all applicable provisions of this article and all applicable laws of foreign jurisdictions, to affect the reorganization.
2023 West Virginia Code › Chapter 33. Insurance › Article 27A. West Virginia Mutual to Mutual Insurance Holding Company Act › §33-27A-11. Applicability of Other Laws

(a) The provisions of 33-5-24 of this code shall apply to a mutual insurance holding company as if the mutual insurance holding company were a domestic mutual insurance company. The members of the mutual insurance holding company are deemed to be members of a domestic mutual insurance company for all purposes of all such sections.
(b) For a period of five years following the effective date of a reorganization under this article, no person shall acquire control of a reorganized stock company without compliance with the provisions of 33-27-1
et seq.
of this code. For purposes of this subdivision, "control" has the same meaning as set out in 33-27-2 of this code, except that control is presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing 5 percent or more of the voting securities of any other person.
(c) An intermediate holding company or if there is no such company, a reorganized stock company shall not issue shares of stock, in addition to the shares issued pursuant to the reorganization plan under which the company was formed, without the prior approval of the mutual insurance holding company as its majority shareholder. The prior approval of the mutual insurance holding company must be evidenced by a resolution of the board of directors of the mutual insurance holding company delivered to the board of directors in the intermediate holding company or the reorganized stock company prior to the issuance of the additional shares.
(d) A mutual insurance holding company, and an intermediate holding company, if any, are deemed to be insurers subject to the provisions of this chapter.
2023 West Virginia Code › Chapter 33. Insurance › Article 27A. West Virginia Mutual to Mutual Insurance Holding Company Act › §33-27A-12. Holding Company Treated as Insurer

(a) A mutual insurance holding company, and, if applicable, its intermediate holding company, are deemed to be insurers subject to the provisions of 33-10-1
et seq.
of this code. A mutual insurance holding company and the intermediate holding company accordingly are deemed to be parties to any proceeding under such article involving an insurance company of the subsidiary of the mutual insurance holding company or of the intermediate holding company as a result of a reorganization under this article.
(b) In any proceeding under 33-10-1
et seq.
of this code involving a reorganized stock company, the assets of the mutual insurance holding company, and if applicable, its intermediate holding company, are deemed to be assets of the reorganization stock company for purposes of satisfying claims of the policyholders of the reorganized stock company.
(c) A mutual insurance holding company, and, if applicable, its intermediate holding company, shall not be dissolved or liquidated without compliance with the provisions of 33-10-1
et seq.
of this code. Such companies are deemed to be domestic insurance companies for purposes of a dissolution or liquidation.
2023 West Virginia Code › Chapter 33. Insurance › Article 28. Individual Accident and Sickness Insurance Minimum Standards › §33-28-2. Purpose of Article

The purpose of this article is to provide reasonable standardization and simplification of terms and coverages of individual accident and sickness insurance policies and subscriber contracts of hospital and medical service corporations in order to facilitate public understanding and comparison and to eliminate provisions contained in individual accident and sickness insurance policies and subscriber contracts of hospital and medical service corporations which may be misleading or confusing in connection either with the purchase of such coverages or with the settlement of claims and to provide for full disclosure in the sale of such coverages.
2023 West Virginia Code › Chapter 33. Insurance › Article 28. Individual Accident and Sickness Insurance Minimum Standards › §33-28-3. Definition of Terms Used in Article

As used in this article, unless used in a context that clearly requires a different meaning, the term:
(a) "Form" means a policy, contract, rider, endorsement or application as provided in section eight, article six of this chapter when used to describe an individual accident and sickness policy form, and means a contract, application, rider or endorsement as provided in section six, article twenty-four of this chapter when used to describe a hospital or medical service corporation subscriber's contract.
(b) "Accident and sickness insurance" means insurance written under article fifteen of this chapter, other than credit accident and sickness insurance, and coverages written under article twenty-four of this chapter. For purposes of this article, hospital, medical and dental service corporations shall be deemed to be engaged in the business of insurance.
(c) "Policy" means the entire contract between an insurer and an individual insured, including the policy, riders, endorsements and the application, if attached. The term "policy" shall not include coverages issued pursuant to a conversion privilege under a policy or contract of group insurance.
(d) "Subscriber contract" means the entire subscriber contract issued by a hospital, medical or dental service corporation to an individual subscriber, including the contract, riders, endorsements and the application, if attached. The term "subscriber contract" shall not include coverages issued pursuant to a conversion privilege under a policy or contract of group insurance.
(e) "Direct response insurance product" means an individual policy of accident and sickness insurance or a subscriber contract of a hospital, medical or dental service corporation, the sale of which is effected through direct contact between an insurer and an individual insured or between a hospital, medical or dental service corporation and a subscriber, without employing the intermediary services of an agent, broker or solicitor.