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2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-105 - Agents of Mechanical Breakdown Insurers.

26-37-105. Agents of mechanical breakdown insurers.
(a) Upon issuance of a certificate of authority under W.S. 26-37-104, a licensed agent appointed to market the casualty insurance policies of the certified mechanical breakdown insurer within this state may market mechanical breakdown insurance policies of that insurer within this state without further licensing, testing or fees from the department.
(b) Agents marketing mechanical breakdown insurance shall comply with all other provisions of this code relating to the transaction of insurance as an agent.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-107 - Mechanical Breakdown Insurance Organizations; Revocation or Suspension of Certificate of Authority.

26-37-107. Mechanical breakdown insurance organizations; revocation or suspension of certificate of authority.
(a) The commissioner shall revoke or suspend the certificate of authority issued to any mechanical breakdown insurance organization under W.S. 26-37-106 if after a hearing in accordance with W.S. 26-2-125 through 26-2-129, he finds the organization:
(i) Violates any provision of this chapter or chapter 13 of this code;
(ii) Is insolvent;
(iii) Has assets less than its liabilities;
(iv) Refuses or any officer refuses to submit to an examination; or
(v) Is transacting business fraudulently.
(b) The commissioner shall give public notice of any revocation or suspension under this section in a manner he deems proper.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-109 - Appointment of Commissioner as Attorney for Mechanical Breakdown Insurance Organization; Service of Process.

26-37-109. Appointment of commissioner as attorney for mechanical breakdown insurance organization; service of process.
Any mechanical breakdown insurance organization desiring to transact business in this state shall file with the commissioner a duly executed instrument whereby the organization shall appoint the commissioner as the attorney of the organization upon whom all lawful process in any action or legal proceeding against it on a contract issued or cause of action arising in this state may be served. In addition, the organization shall agree that any lawful process against it which may be served upon its attorney as provided in this section shall be of the same force and validity as if served upon the organization and that the authority thereof shall continue in force irrevocably so long as any liability of the organization in the state remains outstanding.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-110 - Examination of Mechanical Breakdown Insurance Organizations; Audited Financial Statement.

26-37-110. Examination of mechanical breakdown insurance organizations; audited financial statement.
(a) Every mechanical breakdown insurance organization is subject to examination by the commissioner in the manner and under the conditions provided for examination of insurers pursuant to W.S. 26-2-116 through 26-2-122. In the examination, the assets of any organization are those assets determined by the commissioner to be available for the payment of the obligations of the organization. In accordance with W.S. 26-2-122, the expense of examination shall be paid by the organization.
(b) Instead of examination under subsection (a) of this section, the commissioner may accept a copy of the most recent financial statement of the organization which has been audited by an independent certified public accountant and which demonstrates that the organization is solvent as determined by generally accepted accounting principles.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-111 - Mechanical Breakdown Insurance Organizations; Solicitations to Purchase.

26-37-111. Mechanical breakdown insurance organizations; solicitations to purchase.
No person shall solicit or aid in the solicitation of another person to purchase a policy issued by a mechanical breakdown insurance organization not having a certificate of authority procured pursuant to this act.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-112 - Mechanical Breakdown Insurance Organizations; Misrepresentations as to Service Contracts.

26-37-112. Mechanical breakdown insurance organizations; misrepresentations as to service contracts.
No mechanical breakdown insurance organization, dealer, representative or other person shall in any manner misrepresent the terms, benefits or privileges of any policy issued by the organization.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-114 - Mechanical Breakdown Insurance Organizations; Required Dealer's License.

26-37-114. Mechanical breakdown insurance organizations; required dealer's license.
No person shall act as a mechanical breakdown insurance organization dealer in this state without first procuring a license from the commissioner in accordance with W.S. 26-37-115 through 26-37-119.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-115 - Mechanical Breakdown Insurance Organizations; Application for Dealer's License.

26-37-115. Mechanical breakdown insurance organizations; application for dealer's license.
(a) Application for a license as a mechanical breakdown insurance dealer shall be made to the commissioner upon forms prescribed and furnished by the commissioner. As a part of or in connection with any application, the applicant shall furnish information concerning his identity, personal history, experience, business record and other pertinent facts the commissioner may reasonably require.
(b) If the applicant is a firm, partnership or corporation, the application shall in addition to the requirements of subsection (a) of this section:
(i) Contain the names of all members and officers of the firm, partnership or corporation; and
(ii) Designate who is to exercise the powers to be conferred by the license on the firm, partnership or corporation.
(c) The commissioner shall require each individual of a firm, partnership or corporation to furnish information to the extent as if applying for an individual license.
(d) Any person willfully misrepresenting any fact required to be disclosed in any application is subject to the penalties provided by W.S. 26-1-107.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-116 - Mechanical Breakdown Insurance Organizations; General Conditions for Issuance or Renewal of Dealer's License.

26-37-116. Mechanical breakdown insurance organizations; general conditions for issuance or renewal of dealer's license.
(a) For the protection of the people of this state, the commissioner shall not issue or renew any mechanical breakdown insurance dealer's license:
(i) Unless the applicant is in compliance with this chapter;
(ii) To any person found untrustworthy or incompetent or who has not established to the satisfaction of the commissioner that he is qualified in accordance with this chapter.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-117 - Mechanical Breakdown Insurance Organizations; Qualifications for Dealer's License.

26-37-117. Mechanical breakdown insurance organizations; qualifications for dealer's license.
(a) In addition to conditions specified under W.S. 26-37-116, the commissioner shall issue a mechanical breakdown insurance dealer's license only to an individual otherwise complying with this chapter furnishing evidence satisfactory to the commissioner that he:
(i) Is an adult;
(ii) Has been a bona fide resident of this state for at least three (3) months;
(iii) Is a trustworthy person with a good reputation; and
(iv) Has never been convicted of a felony that relates to the mechanical breakdown insurance profession or to the ability to practice as a mechanical breakdown insurance dealer. The commissioner shall have discretion as to whether to issue a license if there has been a relevant conviction.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-118 - Mechanical Breakdown Insurance Organizations; Form and Content of Dealer's License.

26-37-118. Mechanical breakdown insurance organizations; form and content of dealer's license.
(a) The commissioner shall prescribe the form of the mechanical breakdown insurance dealer's license which shall contain the:
(i) Name of the licensee and his business address;
(ii) Date of issuance and the date of expiration; and
(iii) Name of the represented mechanical breakdown insurance organization.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-119 - Mechanical Breakdown Insurance Organizations; Annual Renewal of Dealer's License; Fee.

26-37-119. Mechanical breakdown insurance organizations; annual renewal of dealer's license; fee.
(a) Mechanical breakdown insurance dealers' licenses are renewable on July 1 of each year.
(b) The license fee is twenty dollars ($20.00) per year.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-120 - Mechanical Breakdown Insurance Organizations; Grounds for Suspension, Revocation or Refusal to Renew Dealer's License Generally.

26-37-120. Mechanical breakdown insurance organizations; grounds for suspension, revocation or refusal to renew dealer's license generally.
(a) The commissioner may suspend, revoke or refuse to renew any mechanical breakdown insurance dealer's license issued under this chapter for any cause specified by this chapter including the following:
(i) A violation or willful participation in a violation of this chapter;
(ii) Obtainment of any license through misrepresentation or fraud;
(iii) Misappropriation, conversion for the use of the licensee or illegal withholding of monies required to be held in a fiduciary capacity;
(iv) Material misrepresentation of the terms or effect of any contract or the engagement in any fraudulent transaction;
(v) A conviction by final judgment of a felony that relates to the mechanical breakdown insurance profession or to the ability to practice as a mechanical breakdown insurance dealer;
(vi) Incompetency, untrustworthiness or a source of injury or loss to the public as demonstrated in the conduct of affairs under a license;
(vii) Misrepresentation of the qualifications of the licensee's representatives;
(viii) Permitting any individual not registered as a representative with the commissioner to act as a representative;
(ix) Any cause of license suspension or revocation provided under W.S. 26-9-211.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-121 - Mechanical Breakdown Insurance Organizations; Grounds for Suspension, Revocation or Refusal of Dealer's License of Firm, Partnership or Corporation.

26-37-121. Mechanical breakdown insurance organizations; grounds for suspension, revocation or refusal of dealer's license of firm, partnership or corporation.
A mechanical breakdown insurance dealer's license issued to any firm, partnership or corporation may be suspended, revoked or refused for any cause relating to any individual designated in the license to exercise its powers.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-122 - Mechanical Breakdown Insurance Organizations; Surrender of Revoked or Suspended License Certificate.

26-37-122. Mechanical breakdown insurance organizations; surrender of revoked or suspended license certificate.
The holder of any mechanical breakdown insurance dealer's license which has been revoked or suspended shall immediately surrender the license certificate to the commissioner.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-123 - Mechanical Breakdown Insurance Organizations; Representatives of Dealers; Registration Required.

26-37-123. Mechanical breakdown insurance organizations; representatives of dealers; registration required.
No person shall act as the representative of a dealer for a mechanical breakdown insurance organization unless he has first been registered with the commissioner pursuant to W.S. 26-37-124.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-124 - Mechanical Breakdown Insurance Organizations; Representatives of Dealers; Registration Requirements; Fee; Renewal; Suspension or Revocation.

26-37-124. Mechanical breakdown insurance organizations; representatives of dealers; registration requirements; fee; renewal; suspension or revocation.
(a) Any dealer for a mechanical breakdown insurance organization shall register its representatives with the commissioner by filing an application for registration stating the:
(i) Name and address of the registrant;
(ii) Registrant has been a resident of this state for at least thirty (30) days preceding the date of application;
(iii) Registrant is a trustworthy person with a good reputation; and
(iv) Registrant is familiar with the benefits, costs, coverage and claims procedure of the mechanical breakdown insurance marketed by the dealer.
(b) The dealer shall pay a registration fee of ten dollars ($10.00) for each individual registered under this section.
(c) Upon payment of a renewal fee of ten dollars ($10.00), representative registrations are renewable on the first day of August of each year unless sooner suspended or revoked.
(d) Representative registrations may be suspended or revoked for those causes and subject to the procedure applicable to dealers under this chapter or to agents of insurers under this code.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-125 - Types of Mechanical Breakdown Insurance; Policy and Certificate Forms; Issuance of Policies and Certificates.

26-37-125. Types of mechanical breakdown insurance; policy and certificate forms; issuance of policies and certificates.
(a) A mechanical breakdown insurer and a mechanical breakdown insurance organization may write mechanical breakdown insurance as individual, group, blanket or franchise insurance. Each contractual obligation for mechanical breakdown insurance shall be evidenced by a policy. Any insured person under a group policy shall be issued a certificate of coverage.
(b) No policy or certificate of mechanical breakdown insurance shall be issued in this state unless a copy of the form has been filed with and approved by the commissioner.
(c) The commissioner shall not approve any form that does not meet the following requirements:
(i) Policies shall contain a list and description of the mechanical breakdown payments promised or the mechanical breakdowns for which expenses are to be reimbursed, any limits on the amounts to be paid or reimbursed and procedures to be followed by the insured and the insurer in the event of a claim;
(ii) Policies and certificates shall indicate the name of the insurer and the full address of its principal place of business;
(iii) Certificates issued under group policies shall contain a full statement of the benefits provided, any exceptions and claim procedures but may summarize the other terms of the master policy; and
(iv) No policy except a policy issued by a mutual or reciprocal insurance company may provide for assessments on policyholders or for reduction of benefits for the purpose of maintaining the insurer's solvency.
(d) The department may disapprove a policy or certificate form if it finds that it:
(i) Is unfair, unfairly discriminatory, misleading, ambiguous or encourages misrepresentation or misunderstanding of the contract;
(ii) Provides coverage or benefits or contains other provisions that endanger the insurer's solvency; or
(iii) Is contrary to law.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-126 - Filing and Approval of Contracts; Annual Reports by Organizations.

26-37-126. Filing and approval of contracts; annual reports by organizations.
(a) Contracts made between the organization and its dealers and representatives and contracts with other providers of services under the mechanical breakdown insurance policy shall be filed with and approved by the commissioner.
(b) Organizations shall annually report to the commissioner in reasonably required detail, the number and geographical distribution of providers of services covered by the mechanical breakdown insurance policy with whom it maintains contractual relations and the nature of the relations. For individual insurers or groups of insurers, the commissioner may require more frequent reports.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 37 - Mechanical Breakdown Insurance › Section 26-37-127 - Rules and Regulations.

26-37-127. Rules and regulations.
After notice and hearing, the commissioner may promulgate rules and regulations necessary to carry out this chapter. Rules and regulations promulgated under this chapter are subject to review in accordance with W.S. 28-9-101 through 28-9-108.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 1 - In General › Section 26-38-102 - Applicability.

26-38-102. Applicability.
The requirements of this article shall apply to policies delivered or issued for delivery in this state on or after the effective date of this article. This article is not intended to supersede the obligations of entities subject to this article to comply with the substance of other applicable insurance laws insofar as they do not conflict with this article, except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance. A policy which is not advertised, marketed or offered as long-term care insurance or nursing home insurance need not meet the requirements of this article.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 1 - In General › Section 26-38-104 - Limits of Group Long-Term Care Insurance.

26-38-104. Limits of group long-term care insurance.
No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in W.S. 26-38-103(a)(iv)(D), unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that those requirements have been met.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 1 - In General › Section 26-38-107 - Incontestability Period.

26-38-107. Incontestability period.
(a) For a long-term care insurance policy or certificate that has been in force for less than six (6) months, an insurer may rescind the policy or certificate or deny any otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance of coverage.
(b) For a long-term care insurance policy or certificate that has been in force for at least six (6) months but less than two (2) years, an insurer may rescind the policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the conditions for which benefits are sought.
(c) After a long-term care insurance policy or certificate has been in force for two (2) years it is not contestable upon the grounds of misrepresentation, unless the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
(d) No long-term care insurance policy or certificate may be field issued based on medical or health status. For purposes of this section, "field issued" means a policy or certificate issued by an agent or a third party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer.
(e) If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
(f) An insurer shall rescind a long-term care policy or certificate for misrepresentation only as provided in this section.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 1 - In General › Section 26-38-109 - Nonforfeiture Benefit Provisions.

26-38-109. Nonforfeiture benefit provisions.
(a) Subject to subsection (g) of this section, an insurer that offers a long-term care insurance policy or certificate in this state shall offer a nonforfeiture protection provision as an option. The nonforfeiture benefit shall be made available in the event of a default in the payment of any premiums, or upon the surrender of the policy or certificate by the policyholder or certificate holder.
(b) Subject to subsection (g) of this section, the nonforfeiture provision offered for a policy which is not intended to be a qualified long-term insurance contract, shall be appropriately captioned and shall provide at least one (1) of the following:
(i) Reduced paid-up insurance;
(ii) Extended term insurance;
(iii) Cash surrender values;
(iv) A return of premium;
(v) A shortened benefit period; or
(vi) Other offerings as approved by the commissioner.
(c) Nonforfeiture benefits shall be computed in an actuarially sound manner, using a methodology that has been filed with and approved by the commissioner. At the time of lapse, or upon request by the policyholder or certificate holder, the insurer shall disclose the then-accrued nonforfeiture values. At the time the policy or certificate is issued, the insurer shall provide to the policyholder or certificate holder schedules demonstrating estimated values of nonforfeiture benefits. The schedules shall state that the estimated values are not to be construed as guaranteed nonforfeiture values.
(d) The amount of nonforfeiture benefits shall be adjusted subsequent to being initially granted only as necessary to reflect changes in claims, persistency and interest as reflected in changes in rates for premium paying policies approved by the commissioner for the same policy form.
(e) This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.
(f) Nonforfeiture benefits for qualified long-term care insurance contracts shall include at least a reduced paid-up insurance benefit, an extended term insurance benefit, the offer of a shortened benefit period, or other similar offerings approved by the secretary of the treasury, and shall be provided as specified in regulations. The issuer of such a contract may refund premiums upon complete surrender or cancellation of the contract or policy, as long as the refund does not exceed the aggregate premiums paid for the contract or policy.
(g) Within fifteen (15) business days following receipt of written proof of the death of an insured, an insurer under this chapter shall refund unearned premiums paid for any period beyond the death of the insured. The amount of the refund shall be pro rata from the date of death.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 1 - In General › Section 26-38-111 - Penalties.

26-38-111. Penalties.
In addition to any other penalties provided by the laws of this state, any insurer or agent who violates any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a civil penalty not to exceed three (3) times the amount of any commissions paid for each policy involved in the violation or ten thousand dollars ($10,000.00), whichever is greater. The penalty shall be assessed by the commissioner in accordance with W.S. 26-1-107.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-201 - Definitions.

26-38-201. Definitions.
(a) As used in this act:
(i) "Applicant" means:
(A) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and
(B) In the case of a group Medicare supplement policy, the proposed certificate holder.
(ii) "Certificate" means any certificate delivered or issued for delivery in this state under a group Medicare supplement policy;
(iii) "Certificate form" means the form on which the certificate is delivered or issued for delivery by the issuer;
(iv) "Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates;
(v) "Medicare supplement policy" means a group or individual disability insurance policy or a subscriber contract of hospital and medical service associations or health maintenance organizations other than a policy issued pursuant to a contract under section 1876 of the federal Social Security Act, or an issued policy under a demonstration project specified in 42 U.S.C. 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare;
(vi) "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended;
(vii) "Policy form" means the form on which the policy is delivered or issued for delivery by the issuer;
(viii) "This act" means W.S. 26-38-201 through 26-38-209.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-202 - Applicability and Scope.

26-38-202. Applicability and scope.
(a) Except as otherwise specifically provided, this act shall apply to:
(i) All Medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this act; and
(ii) All certificates issued under group Medicare supplement policies which have been delivered or issued for delivery in this state.
(b) This act shall not apply to a policy issued to one (1) or more employers or labor organizations, or to the trustees of a fund established by one (1) or more employers or labor organizations, or combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.
(c) Except as provided by regulations adopted pursuant to W.S. 26-38-206(e), the provisions of this act are not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to Medicare eligible persons which policies are not marketed or held to be Medicare supplement policies or benefit plans.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-203 - Standards for Policy Provisions.

26-38-203. Standards for policy provisions.
(a) No Medicare supplement insurance policy or certificate in force in the state shall contain benefits which duplicate benefits provided by Medicare.
(b) The commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this state. No requirement of the code relating to minimum required policy benefits, other than the minimum standards contained in this act, shall apply to Medicare supplement policies and certificates. The standards may cover, but are not limited to:
(i) Terms of renewability;
(ii) Initial and subsequent conditions of eligibility;
(iii) Nonduplication of coverage;
(iv) Probationary periods;
(v) Benefit limitations, exceptions and reductions;
(vi) Elimination periods;
(vii) Requirements for replacement;
(viii) Recurrent conditions; and
(ix) Definitions of terms.
(c) The commissioner shall adopt reasonable regulations that specify prohibited policy provisions not otherwise specifically authorized by statute which, in the opinion of the commissioner, are unjust, unfair or unfairly discriminatory to any person insured or proposed for coverage under a Medicare supplement policy or certificate.
(d) Notwithstanding any other provision of law or contract, a Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than ninety (90) days from the effective date of coverage because the loss involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within ninety (90) days before the effective date of coverage.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-204 - Regulations.

26-38-204. Regulations.
(a) The commissioner shall adopt reasonable regulations to establish minimum standards for benefits, claims payment, marketing practices, compensation arrangements and reporting practices for Medicare supplement policies and certificates.
(b) The commissioner may adopt reasonable regulations necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations, including but not limited to:
(i) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
(ii) Establishing a uniform methodology for calculating and reporting loss ratios;
(iii) Assuring public access to policies, premiums and loss ratio information of issuers of Medicare supplement insurance;
(iv) Establishing a process for approving or disapproving policy forms and certificate forms and restricting premium increases if loss ratio requirements are not met;
(v) Establishing a policy for holding public hearings prior to approval of premium increases; and
(vi) Establishing standards for Medicare select policies and certificates.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-205 - Loss Ratio Standards.

26-38-205. Loss ratio standards.
(a) Repealed by Laws 1992, ch. 57, 2.
(b) Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The commissioner shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-206 - Disclosure Standards.

26-38-206. Disclosure standards.
(a) In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made.
(b) The commissioner shall prescribe both the format and content of the outline of coverage required by subsection (a) of this section. For purposes of this section, "format" means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. The outline of coverage shall include but is not limited to:
(i) A description of the principal benefits and coverage provided in the policy;
(ii) A statement of the exceptions, reductions and limitations contained in the policy;
(iii) A statement of the renewal provisions, including any reservation by the insurer of a right to change premiums and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age;
(iv) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(c) The commissioner may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for Medicare, which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of Medicare. Except in the case of direct response insurance policies, the commissioner may require by regulation that the information brochure be provided to any prospective insureds eligible for Medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the commissioner may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for Medicare, but in no event later than the time the policy is delivered.
(d) The commissioner may adopt reasonable regulations for captions or notice requirements determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not Medicare supplement coverages, for all disability insurance policies sold to persons eligible for Medicare, other than:
(i) Medicare supplement policies; or
(ii) Disability income policies.
(iii) Repealed By Laws 1997, ch. 12, 2.
(iv) Repealed By Laws 1997, ch. 12, 2.
(e) The commissioner may further adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of disability policies, subscriber contracts or certificates by persons eligible for Medicare.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-207 - Notice of Free Examination.

26-38-207. Notice of free examination.
Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the full premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid directly to the applicant by the insurer in a timely manner.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-208 - Filing Requirements for Advertising.

26-38-208. Filing requirements for advertising.
Every issuer of Medicare supplement insurance policies or certificates in this state shall provide to the insurance commissioner a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medium, for review by the commissioner.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 38 - Long-Term Care Insurance › Article 2 - Medicare Supplement Insurance › Section 26-38-209 - Penalties.

26-38-209. Penalties.
(a) In addition to any other applicable penalties for violations of this code, the commissioner may:
(i) Require insurers to cease marketing any Medicare supplement policy or certificate in this state which violates any provision of this act, any other law administered by the commissioner, any regulation promulgated pursuant to this act or any other rule promulgated pursuant to the authority of the commissioner; or
(ii) Require the insurer to take any actions necessary to comply with the provisions of this act.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 39 - Closed Blocks of Business › Section 26-39-101 - Scope.

26-39-101. Scope.
(a) This chapter shall apply to any insurer who has marketed or sold or will market and sell any individual, group or blanket disability insurance contracts to Wyoming residents.
(b) For the purposes of this chapter disability insurance does not include credit disability insurance as defined in W.S. 26-21-102(a)(ii).
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 39 - Closed Blocks of Business › Section 26-39-102 - Definitions.

26-39-102. Definitions.
(a) As used in this act:
(i) "Block of business" means all those individual, group or blanket disability insurance contracts issued by an insurance company under a particular policy form approved by the Wyoming insurance department;
(ii) "Closed block of business" means a block of business where an insurer ceases to market or sell in Wyoming any new individual, group or blanket disability insurance contracts under a particular policy form and no new contracts are being added to the block;
(iii) "Policy form" means a representative insurance contract which has been filed by an insurer for approval by the Wyoming insurance department pursuant to W.S. 26-15-110 so that other contracts with identical language to that of the policy form may be marketed and sold in Wyoming;
(iv) "This act" means W.S. 26-39-101 through 26-39-104.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 39 - Closed Blocks of Business › Section 26-39-103 - Spreading of Risk.

26-39-103. Spreading of risk.
If any insurer closes a block of business in this state, the insurer shall spread the claims experience of the closed block of business to, for like insureds without regard to individual health problems, other blocks of business still being marketed and sold by that insurer in this state when determining what premiums are to be charged for the contracts included in the closed block of business.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 40 - Healthcare Claims Under Specified Standards › Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis › Section 26-40-101 - Scope.

26-40-101. Scope.
This chapter applies to all insurers who solicit or offer for sale in this state individual, group disability or blanket disability policies covering Wyoming residents.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 40 - Healthcare Claims Under Specified Standards › Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis › Section 26-40-102 - Definitions.

26-40-102. Definitions.
(a) As used in this chapter:
(i) "Health care provider" means any physician, hospital or other person licensed or otherwise authorized in this or another state to furnish to any individual medical or dental care, vision care or hospitalization incident to the furnishing of that care or hospitalization for the purpose of preventing, alleviating, curing or healing human illness, injury or physical disability;
(ii) "Usual, customary and reasonable basis" means the method by which an insurer determines the amount to be paid on a claim for disability benefits by comparing the amount of the claim to amounts charged by other health care providers for the same or similar medical services or procedures;
(iii) "Medical necessity," means:
(A) A medical service, procedure or supply provided for the purpose of preventing, diagnosing or treating an illness, injury, disease or symptom and is a service, procedure or supply that:
(I) Is medically appropriate for the symptoms, diagnosis or treatment of the condition, illness, disease or injury;
(II) Provides for the diagnosis, direct care and treatment of the patient's condition, illness, disease or injury;
(III) Is in accordance with professional, evidence based medicine and recognized standards of good medical practice and care; and
(IV) Is not primarily for the convenience of the patient, physician or other health care provider.
(B) A medical service, procedure or supply shall not be excluded from being a medical necessity under this section solely because the service, procedure or supply is not in common use if the safety and effectiveness of the service, procedure or supply is supported by:
(I) Peer reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia and other medical literature that meet the criteria of the National Institutes of Health's Library of Medicine for indexing in Index Medicus (Medline) and Elsevier Science Ltd. for indexing in Excerpta Medicus (EMBASE); or
(II) Medical journals recognized by the Secretary of Health and Human Services under Section 1861(t)(2) of the federal Social Security Act.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 40 - Healthcare Claims Under Specified Standards › Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis › Section 26-40-103 - Payment of Claims.

26-40-103. Payment of claims.
(a) If any disability insurance policy provides for settlement of a claim for payment of medical services or procedures provided by a health care provider using a usual, customary and reasonable basis the insurer shall:
(i) Submit to the department upon request statistical data of health care provider's charges on which the insurer bases payment of claims. Such data shall be submitted upon request of the commissioner, provided, however, no insurer may be required to submit data more than once every six (6) months. The data submitted shall contain only charges for services performed not more than one (1) year prior to the date of the most recent data;
(ii) Provide to the claimant, in writing, a complete explanation of the basis of settlement, if requested by the claimant in writing, and maintain the explanation in the claim file. If the basis of payment is less than the actual charge made by the health care provider, the explanation shall state the specific reason for the amount not paid and may not expressly state that the health care provider is overcharging unless the allegation is substantiated by fact set out in the explanation;
(iii) Settle any claim for medical services or procedures only on the basis of charges made by Wyoming health care providers of similar qualifications or experience for the same or similar medical services or procedures if the service or procedure for which payment is sought was obtained in Wyoming. However, if the profile or survey does not contain a statistically credible sample of charges, the insurer may include in the profile or survey charges from another similar geographic and demographic area so that a reliable basis is established.
(b) Statistical data submitted to the department pursuant to this section shall be confidential in nature and not available for public inspection.
(c) When a disability insurance policy provides for settlement of a claim for payment of medical services or procedures provided by a health care provider using a usual, customary and reasonable basis or any similar basis:
(i) If the commissioner, based either on a review of the statistical data submitted pursuant to subsection (a) of this section or on the receipt of complaints from one (1) or more insureds, has reason to suspect that a claim or one (1) or more classes of claims is not being settled on the basis provided by the policy he may order the company to show cause why the settlement or settlements should not be changed;
(ii) If the commissioner finds, after notice and opportunity for hearing, that the company is not settling a claim or one (1) or more classes of claims on the basis provided by the policy, he may order a different settlement or settlements.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 40 - Healthcare Claims Under Specified Standards › Article 1 - Payment of Claims Under Usual, Customary and Reasonable Basis › Section 26-40-104 - Prohibitions.

26-40-104. Prohibitions.
(a) No person may make payment on a claim for benefits under an individual, group or blanket disability policy covering residents of this state unless such claim payment is made in compliance with this chapter.
(b) Any person who violates any provisions of this chapter is subject to denial, suspension or revocation of a license or certificate of authority in addition to the imposition of any other penalty provided by W.S. 26-1-107.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 41 - Redomestication Model Act › Section 26-41-101 - Approval as a Domestic Insurer.

26-41-101. Approval as a domestic insurer.
Any insurer which is organized under the laws of any jurisdiction other than this state and is admitted to do business in this state for the purpose of writing insurance may become a domestic insurer by meeting the substantive requirements of law relative to the organization and licensing of a domestic insurer of the same type, by designating its principal place of business at a place in this state, and by receiving from the commissioner certification that it is a domestic insurer as if originally formed in the state. The domesticated insurer thereafter will be entitled to domestic certificates and licenses to transact business in this state, and shall be subject to the authority and jurisdiction of this state as a domestic insurer.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 41 - Redomestication Model Act › Section 26-41-102 - Conversion to Foreign Insurer.

26-41-102. Conversion to foreign insurer.
Any domestic insurer may, upon the approval of the commissioner, transfer its domicile to any other state in which it is admitted to transact the business of insurance, and upon such a transfer shall cease to be a domestic insurer, and shall be admitted to this state if qualified as a foreign insurer. The commissioner shall approve any proposed transfer unless he shall determine the transfer is not in the interest of the policyholders of this state.
2023 Wyoming Statutes › Title 26 - Insurance Code › Chapter 41 - Redomestication Model Act › Section 26-41-103 - Effects of Redomestication.

26-41-103. Effects of redomestication.
(a) The certificate of authority, agent appointments and licenses, rates, and other items which the commissioner of insurance allows, in his discretion, which are in existence at the time any insurer licensed to transact the business of insurance in this state transfers its corporate domicile to this or any other state by merger, consolidation, continuance, transfer or any other lawful method shall continue in full force and effect upon the transfer if the insurer remains duly qualified to transact the business of insurance in this state. All outstanding policies of any transferring insurer shall remain in full force and effect and need not be endorsed as to the new name of the company or its new location unless so ordered by the commissioner. Every transferring insurer shall file new policy forms with the commissioner on or before the effective date of the transfer, but may use existing policy forms with appropriate endorsements if allowed by, and under conditions approved by, the commissioner.
(b) The procedures for filing and approval of articles of domestication by the corporate directors shall be the same as those set forth in W.S. 26-24-104 concerning the filing and approval of articles of incorporation for proposed domestic insurers.
(c) The articles of domestication of any insurer transferring its domicile into this state shall be deemed the articles of incorporation of the insurer. The domestication of an insurer into this state shall have the same effect upon the insurer as in the case of a corporation continuing in Wyoming pursuant to W.S. 17-16-1810.