reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.07 - Standard External Review

Current through June 25, 2024
A.
1. Within four (4) months after the date of
				receipt of a notice of an adverse determination or final adverse determination
				pursuant to Rule 15.04 of this Regulation, a covered person or the covered
				person's authorized representative may file a request for an external review
				with the Commissioner.
2. Within
				one (1) business day after the date of receipt of a request for external review
				pursuant to paragraph (1), the Commissioner shall send a copy of the request to
				the health carrier.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.08 - Expedited External Review

Current through June 25, 2024
A. Except as
				provided in subsection F, a covered person or the covered person's authorized
				representative may make a request for an expedited external review with the
				Commissioner at the time the covered person receives:
1. An adverse determination if:
a. The adverse determination involves a
				medical condition of the covered person for which the timeframe for completion
				of an expedited internal review of a grievance involving an adverse
				determination would seriously jeopardize the life or health of the covered
				person or would jeopardize the covered person's ability to regain maximum
				function; and
b. The covered person
				or the covered person's authorized representative has filed a request for an
				expedited review of a grievance involving an adverse determination;
				or
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.10 - Binding Nature of External Review Decision

Current through June 25, 2024
A. An
				external review decision is binding on the health carrier except to the extent
				the health carrier has other remedies available under applicable State
				law.
B. An external review decision
				is binding on the covered person except to the extent the covered person has
				other remedies available under applicable federal or State law.
C. A covered person or the covered person's
				authorized representative may not file a subsequent request for external review
				involving the same adverse determination or final adverse determination for
				which the covered person has already received an external review decision
				pursuant to this Regulation.
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011); Public Law
				  111-148 -Mar. 23, 2010 (Patient Protection and
				  Affordable Care Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.11 - Approval of Independent Review Organizations

Current through June 25, 2024
A. The
				Commissioner shall approve independent review organizations eligible to be
				assigned to conduct external reviews under this Regulation.
B. In order to be eligible for approval by
				the Commissioner under this section to conduct external reviews under this
				Regulation an independent review organization:
1. Except as otherwise provided in this
				section, shall be accredited by a nationally recognized private accrediting
				entity that the Commissioner has determined has independent review organization
				accreditation standards that are equivalent to or exceed the minimum
				qualifications for independent review organizations established under Rule
				15.12 of this Regulation; and
2.
				Shall submit an application for approval in accordance with subsection
				D.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.12 - Minimum Qualifications for Independent Review Organizations

Current through June 25, 2024
A. To be approved under Rule 15.11 of this
				Regulation to conduct external reviews, an independent review organization
				shall have and maintain written policies and procedures that govern all aspects
				of both the standard external review process and the expedited external review
				process set forth in this Regulation that include, at a minimum:
1. A quality assurance mechanism in place
				that:
a. Ensures that external reviews are
				conducted within the specified time frames and required notices are provided in
				a timely manner;
b. Ensures the
				selection of qualified and impartial clinical reviewers to conduct external
				reviews on behalf of the independent review organization and suitable matching
				of reviewers to specific cases and that the independent review organization
				employs or contracts with an adequate number of clinical reviewers to meet this
				objective;
c. Ensures the
				confidentiality of medical and treatment records and clinical review criteria;
				and d. Ensures that any person employed by or under contract with the
				independent review organization adheres to the requirements of this
				Regulation;
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.13 - Hold Harmless for Independent Review Organization

Current through June 25, 2024
No independent review organization or clinical reviewer
				  working on behalf of an independent review organization or an employee, agent
				  or contractor of an independent review organization shall be liable in damages
				  to any person for any opinions rendered or acts or omissions performed within
				  the scope of the organization's or person's duties under the law during or upon
				  completion of an external review conducted pursuant to this Regulation, unless
				  the opinion was rendered or act or omission performed in bad faith or involved
				  gross negligence.
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011); Public Law
				  111-148 -Mar. 23, 2010 (Patient Protection and
				  Affordable Care Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.14 - External Review Reporting Requirements

Current through June 25, 2024
A.
1. An independent review organization
				assigned pursuant to Rule 15.07, Rule 15.08 or Rule 15.09 of this Regulation to
				conduct an external review shall maintain written records in the aggregate by
				State and by health carrier on all requests for external review for which it
				conducted an external review during a calendar year and, upon request, submit a
				report to the Commissioner, as required under paragraph (2).
2. Each independent review organization
				required to maintain written records on all requests for external review
				pursuant to paragraph (1) for which it was assigned to conduct an external
				review shall submit to the Commissioner, upon request, a report in the format
				specified by the Commissioner. The Independent Review Organization External
				Review Annual Report Form attached hereto as Rule 15.22 - Appendix "C" meets
				all form and content requirements of this section.
3. The report shall include in the aggregate
				by State, and for each health carrier:
a. The
				total number of requests for external review;
b. The number of requests for external review
				resolved and, of those resolved, the number resolved upholding the adverse
				determination or final adverse determination and the number resolved reversing
				the adverse determination or final adverse determination;
c. The average length of time for
				resolution;
d. A summary of the
				types of coverages or cases for which an external review was sought, as
				provided in the format required by the Commissioner;
e. The number of external reviews pursuant to
				Rule 15.07(G) of this Regulation that were terminated as the result of a
				reconsideration by the health carrier of its adverse determination or final
				adverse determination after the receipt of additional information from the
				covered person or the covered person's authorized representative; and
f. Any other information the
				Commissioner may request or require.
4. The independent review organization shall
				retain the written records required pursuant to this subsection for at least
				three (3) years.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.15 - Funding of External Review

Current through June 25, 2024
The health carrier against which a request for a standard
				  external review or an expedited external review is filed shall pay the cost of
				  the independent review organization for conducting the external
				  review.
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011); Public Law
				  111-148 -Mar. 23, 2010 (Patient Protection and
				  Affordable Care Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.16 - Disclosure Requirements

Current through June 25, 2024
A.
1. Each health carrier shall include a
				description of the external review procedures in or attached to the policy,
				certificate, membership booklet, outline of coverage or other evidence of
				coverage it provides to covered persons.
2. The disclosure required by paragraph (1)
				shall be in a format approved by the Commissioner.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.17 - Filing of Forms

Current through June 25, 2024
Any forms issued by a health carrier to the covered person or
				  the covered person's authorized representative pursuant to this regulation must
				  be filed with and approved by the Commissioner prior to use.
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011); Public Law
				  111-148 -Mar. 23, 2010 (Patient Protection and
				  Affordable Care Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.18 - Severability

Current through June 25, 2024
If any provision of this Regulation, or the application of
				  the provision to any person or circumstance shall be held invalid, the
				  remainder of the Regulation, and the application of the provision to persons or
				  circumstances other than those to which it is held invalid, shall not be
				  affected.
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011); Public Law
				  111-148 -Mar. 23, 2010 (Patient Protection and
				  Affordable Care Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.19 - Effective Date

Current through June 25, 2024
This Regulation shall be effective on January 1,
				  2013.
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011); Public Law
				  111-148 -Mar. 23, 2010 (Patient Protection and
				  Affordable Care Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.21 - Appendix B - External Review Request Form

Current through June 25, 2024
This
EXTERNAL REVIEW REQUEST FORM
must be filed
				  with Mississippi Insurance Department within
FOUR (4) MONTHS
after
				  receipt from your insurer of a denial of payment on a claim or request for
				  coverage of a health care service or treatment.
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WHAT TO SEND AND WHERE TO SEND IT
PLEASE CHECK BELOW (NOTE: YOUR REQUEST WILL NOT BE
				  ACCEPTED FOR FULL REVIEW UNLESS ALL FOUR (4) ITEMS BELOW ARE
				  INCLUDED*)
1.
[]
[]
YES
, I have included this completed application
				form signed and dated.
2.
[]
[]
YES
, I have included a photocopy of my insurance
				identification card or other evidence showing that I am insured by the health
				insurance company named in this application;
3.
[]
[]
YES
, I have
				enclosed the letter from my health carrier or utilization review company that
				states:
(a) Their decision is final and that I
				have exhausted all internal review procedures; or
(b) They have waived the requirement to
				exhaust all of the health carrier's internal review procedures.
**You may make a request for external review without
				  exhausting all internal review procedures under certain circumstances. You
				  should contact the Office of the Insurance Commissioner, Mississippi Insurance
				  Department, Attn: Life and Health Actuarial Division, P.O. Box 79, Jackson, MS
				  39205, Phone: (601) 359-3569.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.22 - Appendix C - Independent Review Organization External Review Annual Report Form

Current through June 25, 2024
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Miss. Code Ann. §
										83-5-1
				  (Rev. 2011); Public Law
				  111-148 -Mar. 23, 2010 (Patient Protection and
				  Affordable Care Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 15 - Mississippi Health Carrier External Review Regulation › Rule 19-3-15.23 - Appendix D - Health Carrier External Review Annual Report Form

Current through June 25, 2024
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Miss. Code Ann. §
				  83- 5-1 (Rev. 2011); Public Law 111-148 -Mar. 23,
				  2010 (Patient Protection and Affordable Care
				  Act)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 16 - Form and Manner of Notices When Renewing a Product in the Individual Market › Rule 19-3-16.01 - Authority

Current through June 25, 2024
This regulation is adopted and promulgated pursuant to the
				  authority granted by
Miss. Code Ann
. Section
				  83-5-1
				  (Rev. 2011), and in accordance with the provisions of the Administrative
				  Procedures Act found at
Miss Code Ann
. 25-43-1, et seq., and
				  the Mississippi Insurance Department Regulation 19 Miss. Admin. Code, Part 1,
				  Chapter 15, said regulation being the "Rules of Practice and Procedure before
				  the Mississippi Insurance Department".
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 16 - Form and Manner of Notices When Renewing a Product in the Individual Market › Rule 19-3-16.02 - Purpose

Current through June 25, 2024
The Centers for Medicare and Medicaid Services (CMS) issued a
				  Bulletin entitled
Form and Manner of Notices when Discontinuing or
				  Renewing a Product in the Small Group or Individual Market
on
				  September 2, 2014. Under 45 CFR Sections 146.152, 147.106, and 148.122 an
				  issuer that discontinues or renews a particular individual product must provide
				  notice of such discontinuation or renewal in a form and manner specified by the
				  Secretary of Health and Human Services. States that are enforcing the
				  Affordable Care Act may, without obtaining further approval from CMS, develop
				  their own notice for renewal, provided the State-developed notice is at least
				  as protective as the Federal standard notice. The purpose and intent of this
				  regulation is to provide issuers with a State-developed renewal notice to be
				  used when renewing an individual product.
45 CFR §§
				  146.152, 147.106, and 148.122; Miss. Code Ann. §
										83-5-1
				  (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 16 - Form and Manner of Notices When Renewing a Product in the Individual Market › Rule 19-3-16.03 - Adoption of a Mississippi Renewal Form for Individual Products

Current through June 25, 2024
In accordance with CMS guidance, the Mississippi Department
				  of Insurance ("Department") has created a form entitled "Renewal Form for
				  Individual Products" ("Form"), which is found in Rule 16.06 of this Regulation.
				  Issuers may begin using this form immediately, without the necessity of
				  obtaining prior approval from the Department. Minor non-substantive changes
				  which identify the issuer or which provide contact information are allowed.
				  Material changes or additions to the form are not allowed.
45 CFR §§
				  146.152, 147.106, and 148.122; Miss. Code Ann. §
										83-5-1
				  (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 16 - Form and Manner of Notices When Renewing a Product in the Individual Market › Rule 19-3-16.04 - Severability Clause

Current through June 25, 2024
If any provision of this regulation, or the application
				  thereof to any person or circumstance, is held invalid, such determination
				  shall not affect other provisions or applications of this regulation which can
				  be given effect without the invalid provision or application, and to that end
				  the provisions of this regulation are severable.
Miss. Code Ann. §
										83-5-1
				  (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 16 - Form and Manner of Notices When Renewing a Product in the Individual Market › Rule 19-3-16.05 - Effective Date

Current through June 25, 2024
This Regulation shall be effective thirty (30) days after
				  final adoption with the Office of the Secretary of State.
Miss. Code Ann.
				  §§
										25-43-3.108;
				  25-43-3.112; 83-5-1 (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 17 - Large Group Health Insurance Claims Data Reporting › Rule 19-3-17.01 - Authority

Current through June 25, 2024
This regulation is adopted and promulgated pursuant to the
				  authority granted by Miss. Code Ann. §
									83-5-1,
				  §§
									83-9-1
				  et seq., §§
									83-41-401
				  et seq. and in accordance with the provisions of the Administrative Procedures
				  Act found at Miss Code Ann. § 25-43-1 et seq.
Miss. Code Ann.
				  §§ 25-43-1 et seq.; §
										83-5-1;
				  §§
										83-9-1
				  et seq., §
										83-41-401,
				  et seq. (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 17 - Large Group Health Insurance Claims Data Reporting › Rule 19-3-17.02 - Purpose and Scope

Current through June 25, 2024
A. Purpose. The
				purpose of this regulation is to establish requirements for companies who offer
				fully insured, comprehensive, major medical health insurance products on the
				remittance of certain claims data to large employer groups as defined by
				Mississippi Insurance Department Bulletin 2016-9, entitled, "Clarification on
				How and When Employees Must be Counted for the Purposes of Determining Group
				Health Plan Size."
B. Scope. This
				regulation shall apply to all health carriers that offer managed care
				plans.
Miss. Code Ann. §
										83-5-1;
				  §§
										83-9-1
				  et seq., §
										83-41-405;
				  §
										83-41-413
				  (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 17 - Large Group Health Insurance Claims Data Reporting › Rule 19-3-17.03 - Claims Data Reporting

Current through June 25, 2024
A. Upon request by
				a large employer group ("group") or the group's agent or broker, the group's
				health carrier shall make available the currently available summary health
				information, aggregate paid claim, and premium data accumulated for the current
				and the immediately preceding policy period. The company shall make this data
				available within ten (10) business days of the request.
B. The company may condition the remittance
				of the data on both the execution of an agreement for immunity from civil
				liability and a certification of compliance with the federal rules concerning
				privacy of individually identifiable health information found in
				45 C.F.R. Section
				164.504(f)(2).
C. All group claims data reports provided
				pursuant to this regulation shall include all data available to the company as
				of the date of the request and shall include the following information:
1. The net claims paid by month during the
				current and the immediately preceding policy period.
2. The monthly enrollment by employee only,
				employee and spouse, employee and child(ren), and the employee and family
				during the current and the immediately preceding policy period.
3. The amount of any claims reserve
				established by the insurance company against future claims under the policy, to
				the extent the company maintains claims reserves on a group policyholder
				basis.
4. Claims over twenty-five
				thousand dollars ($25,000.00) including claim identifier, the date of
				occurrence, the amount of claims paid and those unpaid or outstanding, and
				claimant health condition or diagnosis during the current and the immediately
				preceding policy period. The data shall provide a unique identifying number or
				code for the claimant.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 17 - Large Group Health Insurance Claims Data Reporting › Rule 19-3-17.04 - Severability

Current through June 25, 2024
If any section or portion of a section of this regulation or
				  the application thereof to any person or circumstance is held by a court to be
				  invalid, such invalidity shall not affect any other provision of that section
				  or application of this regulation which can be given effect without the invalid
				  provision or application, and to this end the provisions of this regulation are
				  declared to be severable.
Miss Code Ann.§
										83-5-1
				  (Rev. 2011).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 17 - Large Group Health Insurance Claims Data Reporting › Rule 19-3-17.05 - Effective Date

Current through June 25, 2024
This regulation shall become effective thirty (30) days after
				  filing for final adoption with the Office of the Secretary of State.
Miss Code Ann.§
										25-43-3.112;
				  §
										25-43-3.113
				  (Rev. 2018).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 2 - (2002-1) Non-Stacking Uninsured Motorist Insurance Coverage › Rule 19-4-2.01 - Authority

Current through June 25, 2024
This Regulation is promulgated by the Commissioner of
				  Insurance pursuant to the authority granted to him by
Miss. Code
				  Ann
. §
									83-5-1
				  and
Miss. Code Ann
. §
									83-11-102
				  as enacted in the 2002 Regular Session of the Mississippi Legislature, and
				  amended by House Bill 545, 2013 Regular Session, as well as the provisions of
				  the Mississippi Department of Insurance Regulation No. 88-101, and regulation
				  being the Rules of Practice and Procedure before the Mississippi Insurance
				  Department.
Miss. Code Ann.
				  §§
										83-5-1;
				  83-11-102 (Rev 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 2 - (2002-1) Non-Stacking Uninsured Motorist Insurance Coverage › Rule 19-4-2.02 - Purpose

Current through June 25, 2024
The purpose of this Regulation is to provide a form for
				  insurers to use in the course of the sale or issuance of multi-vehicle, non
				  stacking uninsured motorist insurance coverage which informs the named insured
				  or applicant of the limitation on stacking imposed and that such coverage is an
				  alternative to coverage without such limitation in accordance with
Miss. Code Ann
. §
									83-11-102
Source:Miss. Code Ann.
				  §
										83-11-102
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 2 - (2002-1) Non-Stacking Uninsured Motorist Insurance Coverage › Rule 19-4-2.03 - Coverages Under a Non-stacking Policy

Current through June 25, 2024
Insurers may offer multi-vehicle, non-stacking uninsured
				  motorist insurance coverage to an insured in an automobile liability policy
				  that covers four (4) or more vehicles. Insurers must offer uninsured motorist
				  insurance that would cover bodily injury and property damage with limits no
				  less than four times those in the Mississippi Motor Vehicle safety
				  Responsibility Law in accordance with
Miss. Code Ann
.
				  §
									83-11-101
				  and §
									83-11-102.
				  The Mississippi Motor Vehicle Safety Responsibility Law sets out minimum split
				  limits of twenty-five thousand dollars ($25,000) for bodily injury to or death
				  of one person in any one accident, fifty thousand dollars ($50,000) for bodily
				  injury to or death of two or more persons in any one accident, and twenty-five
				  thousand dollars ($25,000) for injury to or destruction of property of
				  others.
Thus, the minimum limits an insurer must offer for a
				  non-stacking uninsured motorist insurance policy are one hundred thousand
				  dollars ($100,000) for bodily injury to or death of one person in any one
				  accident, two hundred thousand dollars ($200,000) for bodily injury to or death
				  of two or more persons in any one accident, and one hundred thousand dollars
				  ($100,000) for injury to or destruction of property of others. Should the
				  minimum requirements in the Mississippi Motor Vehicle Safety Responsibility law
				  be increased, the minimum limits for the non-stacking uninsured motorist
				  coverage must be increased accordingly.
Miss. Code Ann.
				  §§
										§§
										63-15-3,
				  63-15-11,
				  63-15-31;
				  63-15-43 (Rev. 2004); 83-11-101; 83-11-102 (Rev.
				  2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 2 - (2002-1) Non-Stacking Uninsured Motorist Insurance Coverage › Rule 19-4-2.04 - Disclosures of Limitations of Non-Stacking Policy

Current through June 25, 2024
A disclosure document containing the disclosures required in
Miss. Code Ann
. §
									83-11-102
				  and this regulation shall be provided in the course of the sale or issuance of
				  non-stacking uninsured motorist coverage. Said disclosure document shall be in
				  the form of the disclosure listed in Appendix A.
Miss. Code Ann. §
										83-11-102
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 2 - (2002-1) Non-Stacking Uninsured Motorist Insurance Coverage › Rule 19-4-2.05 - Severability

Current through June 25, 2024
If any provision of any section of this Regulation or the
				  application thereof is held by a court to be invalid, such invalidity shall not
				  affect any other provision of that section or application of the Regulation
				  which can be given effect without the invalid provision or application, and to
				  this end the provisions of the Regulation are declared to be
				  severable.
Source:Miss. Code
				  Ann.§
										83-5-1
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 2 - (2002-1) Non-Stacking Uninsured Motorist Insurance Coverage › Rule 19-4-2.06 - Effective Date

Current through June 25, 2024
The Effective Date of this Regulation shall be July 1,
				  2013.
House Bill 545, 2013
				  Regular Session; Miss. Code Ann. §
										25-43-3.113
				  (Rev. 2010)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Assigned Risk Plan

Current through June 25, 2024
Introduction.
The Mississippi Automobile
				Insurance Assigned Risk Plan ("the Plan"), established by
Miss.
				Code Ann
. §
								63-15-65, is
				an agreement among insurance companies for granting automobile bodily injury
				and property damage liability insurance to risks unable to secure it for
				themselves.
Miss. Code Ann. §
									63-15-65
				(Rev. 2004)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.01 - Purposes of Plan

Current through June 25, 2024
The purposes of the Plan are to make automobile bodily
				  injury, property damage, and medical payment liability insurance available to
				  vehicles registered with the Mississippi Division of Motor Vehicles, subject to
				  the conditions hereinafter stated and in the Mississippi Plan of Operation
				  (hereinafter the "Plan of Operation") and the Mississippi Automobile Insurance
				  Plan of Rules and Rates (hereinafter the "Plan Manual"). The Plan may issue
				  private passenger motor vehicle policies, and commercial motor vehicle policies
				  in the name of the Plan. Such policies shall be recognized as if issued by an
				  insurance company authorized to issue insurance in this state. The Plan shall
				  also establish procedures for the sharing of premium, losses, costs, and
				  expenses generated by the Personal Automobile Insurance Procedure (hereinafter
				  "PAIP") among all subscriber companies writing voluntary private passenger
				  non-fleet (hereinafter "PPNF") and the Commercial Automobile Procedure
				  (hereinafter "CAIP") among all subscriber companies writing voluntary other
				  than private passenger (hereinafter "OTPP") policies in the State of
				  Mississippi. Copies of the Plan of Operation or Plan Manual may be obtained at
www.aipso.com/ms or
				  by calling 1-800-301-6477
.
Miss. Code Ann.
				  §§
										83-5-1 (Rev. 2011); 63-15-65 (Rev.
				  2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.02 - Effective Date

Current through June 25, 2024
The Plan became effective in February of 1949 when all
				  companies licensed to write direct automobile bodily injury liability insurance
				  in the state have subscribed thereto. The requirements in this Regulation shall
				  become effective upon adoption. No company which is licensed to write only
				  reinsurance shall be a subscriber to this plan.
Miss. Code Ann.
				  §
										25-43-3.102 (Rev. 2010).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.03 - Residents and Non-Residents

Current through June 25, 2024
A. Except as may
				be otherwise provided, the Plan shall be available to residents and
				nonresidents of the state only with respect to automobiles that are registered
				in the state, except that non-residents who are members of the United States
				military forces shall be eligible with respect to automobiles registered in
				other states provided such military non-residents are stationed in this state
				at the time application is made and are otherwise eligible for insurance under
				the Plan.
B. A motor vehicle
				registered in Mississippi, and principally garaged in another state shall be
				subject to the rates, additional charges, rating rules and policy forms
				applicable under the Automobile Insurance Plan of the state of principal
				garaging, and such applicants shall be assigned to companies licensed to write
				and writing automobile liability insurance in that state.
C. When a vehicle registered in Mississippi
				is principally garaged in another state whose Automobile Insurance Plan does
				not provide for physical damage coverage such risk shall be subject to
				whichever of the following will produce the higher dollar amount:
1. The rates applicable to the Mississippi
				territory determined by the address shown on the registration, and otherwise
				subject to all of the provisions of this Plan, or
2. The rules, rates, minimum premiums,
				classifications in force and rating plans applicable in the state and territory
				where the vehicle is principally garaged, and otherwise subject to all of the
				provisions of this Plan.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.04 - Administration

Current through June 25, 2024
The Plan shall be administered by a Governing Committee and a
				  Manager. The Governing Committee (hereinafter referred to as "the Committee")
				  must be approved by the Commissioner of Insurance and shall consist of nine
				  voting members, who are Plan Subscriber Companies, two non-voting members who
				  are licensed Mississippi resident property and casualty insurance producers and
				  two ex officio non-voting members.
A.
				Subscriber Companies shall be chosen from each of the following classes of
				insurers:
1. Six Subscribers from the American
				Property Casualty Insurers Association (APCIA);
2. Three Subscribers from the Non-Affiliated
				Insurance Companies (NAF)
When the APCIA or NAF are unable to appoint one or more
				  subscriber companies to serve on the Governing Committee, the vacant seat shall
				  be opened up to any subscriber company for that term only. The company to fill
				  the vacancy for that term only will be chosen by a process to be determined by
				  the Governing Committee. At the end of the term, the seat will be resumed by a
				  representative from the respective class of company.
Each voting member serving on the Committee shall designate a
				  representative to act on its behalf. This representative shall be either (1) a
				  salaried employee or officer of the named subscriber company or (2) a salaried
				  employee of officer of another subscriber company from a group of companies
				  under the same management as the named subscriber company. A salaried employee
				  or officer of the holding company of the named subscriber company may also be
				  designated as the representative.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.05 - Duties of Governing Committee

Current through June 25, 2024
The Committee shall meet as often as may be required to
				  perform the general duties of administration of the Plan. A majority of the
				  filled voting members' seats of the Committee shall constitute a quorum.
The Committee shall be empowered to appoint a Manager, budget
				  expenses, levy assessments, disburse funds and perform all duties essential to
				  the proper administration of the Plan.
Upon request, the Committee shall furnish to any subscribers
				  to the Plan, a written report of operations annually in such form and detail as
				  the Committee may determine. The annual report shall be available on the Plan
				  website. In addition, hardcopies of the report may be available by contacting
				  the Plan.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.06 - Subscriber Participation

Current through June 25, 2024
A. The Plan
				shall establish a procedure to perform all such policy holder and claim
				handling services as may be necessary to administer the PAIP.
B. The Plan shall distribute CAIP
				applications to the CAIP servicing carriers for servicing of eligible
				risks.
C. Company groups under the
				same ownership may elect to be treated as one company to receive assessments,
				and for PAIP and CAIP participation ratios.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.07 - Cost of Administration

Current through June 25, 2024
Each company subscribing to the Plan shall pay a minimum
				  annual fee and assessments as provided in the Plan of Operation, each for
				  liability and for physical damage insurance.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.08 - Eligibility

Current through June 25, 2024
A. To be eligible for bodily injury, property
				damage, medical payments, and physical damage coverage's, the applicant must
				meet the following criteria:
1. As a
				prerequisite to consideration for coverage through the Plan, an applicant must
				certify, in the prescribed application form, that he has attempted, within 60
				days prior to the date of application, to obtain automobile insurance in the
				State and that he has been unable to obtain such insurance.
2. An applicant so certifying shall be
				considered for coverage through the Plan upon making application in good faith
				to the Plan. An applicant shall be considered in good faith if he reports all
				information of a material nature, and does not willfully make incorrect or
				misleading statements, in the prescribed application form, or does not come
				within any of the prohibitions or exclusions specified in the Plan of Operation
				or Plan Manual.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.09 - Extent of Coverage

Current through June 25, 2024
A. The Plan or
				CAIP servicing carrier shall be required to write a policy or binder at a
				minimum for the limits in the Financial Responsibility law of the
				State.
B. Notwithstanding paragraph
				A, upon request of any applicant, the Plan or CAIP servicing carrier shall
				provide limits adequate to comply with the provisions of the Financial
				Responsibility Law of any state in which the motor vehicle will be operated,
				but applicable only while the motor vehicle is being operated in that
				state/province.
C. Upon request of
				the insured, a standard loss payable clause for the benefit of a lien-holder
				shall be included in the policy.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.10 - Application for Assignment

Current through June 25, 2024
The application for insurance under the Plan must be
				  submitted to the Plan on a prescribed form accompanied by the appropriate
				  premium as specified in the Plan of Operation. If the applicant is ineligible
				  for coverage, the deposit shall be returned. No coverage will be in effect if
				  the premium remittance which accompanies the application is justifiably
				  dishonored by the financial institution. Producers may not deduct commission
				  from the premium submitted with the application. The producer must compute the
				  premium for each risk and show the computed premium on the application. If
				  computation is not shown, the application will be returned. The Plan will not
				  estimate a premium.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.11 - Designation of Company and Effective Date of Coverage

Current through June 25, 2024
Upon receipt of the application for insurance properly
				  completed and the deposit specified in the Plan of Operation, and if the
				  application form shows that the applicant is eligible for coverage, the Plan
				  shall so advise the applicant and producer of record and shall state in such
				  notice the date when the coverage shall become effective. The Plan shall give
				  written notice to the CAIP servicing carrier of the name of the applicant, the
				  producer of record, the coverage to be afforded and the effective date of
				  coverage.
If for any reason, the applicant refuses to accept the
				  policy, the Plan or CAIP servicing carrier shall retain the premium as allowed
				  in the Plan of Operation or Plan Manual.
The Plan shall forward to the CAIP servicing carrier, a copy
				  of the application form, the notice of the effective date of coverage, and the
				  deposit, same to be credited by the CAIP servicing carrier against the policy
				  premium.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.12 - Assignment Period

Current through June 25, 2024
The Plan or CAIP servicing carrier shall write the applicant
				  for a period of three consecutive years, except in the event a financial
				  responsibility filing is required, the Plan or CAIP servicing carrier shall
				  carry the risk for the period of Financial Responsibility Filing, but in no
				  event in excess of 5 years. The Plan or CAIP servicing carrier shall not extend
				  or offer to renew a policy beyond the fifth year. If an insured is unable to
				  obtain insurance at the end of the 3 year period, reapplication for insurance
				  may be made to the Plan. Such reapplication shall be considered as a new
				  application.
In the case of non-resident military personnel, the Plan or
				  CAIP servicing carrier, shall not be required to renew if at the time of
				  renewal the insured is stationed in another state and his/her automobile is not
				  registered in Mississippi.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.13 - Notice to Applicant

Current through June 25, 2024
For private passenger risks and risks serviced by a CAIP
				  servicing carrier, issuance of the original or renewal policy and the making of
				  Financial Responsibility filings shall all be done in accordance with the
				  applicable provisions of the Plan of Operation or Plan
				  Manual.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.15 - Rates

Current through June 25, 2024
A. All risks placed through the Plan shall be
				subject to the rules, rates, surcharges, minimum premiums and classifications
				filed on behalf of all companies subscribing to this Plan by AIPSO and approved
				by the Mississippi Department of Insurance. The rate applicable to any risk
				placed through the plan shall be determined in accordance with the applicable
				provisions as set forth in the Plan Manual.
B. For the purposes of such filings, each
				company subscribing to this Plan is a subscriber to the AIPSO and authorizes
				the Mississippi Insurance Department to accept such filings on its
				behalf.
C. All of the statistical
				data required to develop the appropriate rate shall be furnished to AIPSO by
				each company subscribing to this Plan or by a statistical agency designated by
				such company.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.15.01 - Standard Policy Coverage

Current through June 25, 2024
A. Personal Auto
				Policy
Coverage for private passenger automobiles, as defined in the
				  Plan of Operation and Plan Manual, which have four wheels and are owned or
				  hired under a long-term contract by an individual or by husband and wife who
				  are residents in the same household and written on a specified car basis; for
				  private passenger automobiles owned or hired under a longterm contract by
				  relatives other than husband and wife or resident individuals and for
				  motorcycles or similar type motor vehicles or motor homes; and for named
				  non-owner risks, shall be provided uniform coverage equivalent to the coverage
				  of the Edition of the Insurance Service Office, Inc. (ISO) Personal Auto Policy
				  and the ISO and Automobile Insurance Plan endorsements which have been approved
				  by the Mississippi Insurance Department for use with Plan business.
B. CAIP Commercial Policy
Commercial risks shall be provided uniform coverage,
				  equivalent to the coverage of the ISO Commercial Auto Coverage Part Program and
				  the ISO and Automobile Insurance Plan endorsements which have been approved by
				  the Mississippi Insurance Department for use with Plan business.
Policies issued under the provisions of the Mississippi
				  Commercial Automobile Part of the Plan of Operation shall indicate that they
				  have been issued on behalf of the Plan.
Any required filings of policy or endorsement forms shall be
				  made on behalf of all companies subscribing to this Plan by AIPSO. For the
				  purposes of such filings, each company subscribing to the Plan is a subscriber
				  to AIPSO.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004); 83-5-1 (Rev.
				  2004).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 3 - Mississippi Automobile Insurance Plan › Rule 19-4-3.16 - Cancellations

Current through June 25, 2024
A. Cancellation at Request of Insured.
If for any reason the insured requests a cancellation, the
				  Plan or CAIP servicing carrier shall retain the earned premium for the period
				  of coverage and 10% of the pro rata unearned policy premium, or the minimum
				  policy premium as contained in the Plan Manual, whichever is greater, and
				  return the balance to the insured except in the cases indicated in the Plan of
				  Operation or Plan Manual where the return premium shall be computed pro
				  rata.
B. Cancellation by
				the Plan or by the CAIP Servicing Carrier
The Plan, or CAIP servicing carrier which has issued a policy
				  or binder under this Plan, shall have the right to cancel the insurance by
				  giving appropriate notice as required in the policy or binder only for the
				  reasons specified in the Plan of Operation unless otherwise specified by
				  law.
Nothing herein shall be deemed to affect the Plan's or the
				  CAIP servicing carrier's right to rescind a policy for fraud or
				  misrepresentation or if the insured's premium remittance which accompanies the
				  application is justifiably dishonored by the financial institution, or to
				  invoke other remedies provided by law.
Miss. Code Ann.
				  §
										63-15-65 (Rev. 2004).