reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-6 - Reporting Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. On or
				before March 1 of each year, each licensed provider shall make an annual report of
				all viatical settlement contract transactions in which the viators were residents at
				the time the contract was initiated. Relocation out of state by a viator does not
				relieve the licensed provider from reporting transaction activities for such viator.
				The report shall contain the following information for the previous calendar year:
6.1.a. For each viatical settlement contract
				entered into during the reporting period:
6.1.a.1.
				Date of viatical settlement contract;
6.1.a.2. Viator's state of residence at the time
				of the contract;
6.1.a.3. Life
				expectancy of the insured at the time of contract in months;
6.1.a.4. Face amount of policy
				viaticated;
6.1.a.5. Net death benefit
				viaticated;
6.1.a.6. Estimated total
				premiums to keep policy in force for mean life expectancy;
6.1.a.7. Net amount paid to viator;
6.1.a.8. Source of policy (B-Broker, D-Direct
				Purchase);
6.1.a.9. Type of coverage
				(I-Individual or G-Group);
6.1.a.10.
				Whether or not the viatical settlement contract was entered into during the policy's
				contestable or suicide period, or both;
6.1.a.11. Classification of the viator's or
				insured's diseases or injuries:
6.1.a.11.A.
				Cardiovascular diseases;
6.1.a.11.B.
				Diseases of the central nervous system;
6.1.a.11.C. Diseases of the peripheral nervous
				system;
6.1.a.11.D. Elders with
				nonspecific disease processes;
6.1.a.11.E. Infectious diseases and autoimmune
				diseases;
6.1.a.11.F. Liver and renal
				diseases;
6.1.a.11.G.
				Neoplasms;
6.1.a.11.H. Non-neoplastic
				pulmonary diseases;
6.1.a.12.
				Type of funding for viatical settlement contracts (P-purchaser, L-licensee,
				I-accredited investor, F-financing entity, S-special purpose entity, R-related
				provider trust); and
6.1.a.13. Rating of
				insurer that issued the policy at the time the policy was
				viaticated.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-7 - General Rules

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Payment of the
				proceeds of a viatical settlement contract pursuant to W. Va. Code §
									33-13C-10 shall be by
				means of wire transfer to an account designated by the viator or by certified check
				or cashier's check.
7.2. Payment of the
				proceeds payable to the viator pursuant to a viatical settlement contract shall be
				made in a lump sum except where the viatical settlement provider has purchased an
				annuity or similar financial instrument issued by a licensed insurance company, bank
				or an affiliate of either. Retention of a portion of the proceeds not disclosed or
				described in the viatical settlement contract by the viatical settlement provider or
				escrow agent is not permissible without written consent of the viator.
7.3. A viatical settlement provider or a viatical
				settlement broker shall not discriminate in the making or soliciting of viatical
				settlement contracts or discriminate between viators with dependents and
				without.
7.4. A viatical settlement
				provider shall not knowingly solicit purchasers who have treated or have been asked
				to treat the illness of the viator whose coverage would be the subject of the
				investment.
7.5. If a viatical
				settlement provider enters into a viatical settlement contract that allows the
				viator to retain an interest in the policy, the viatical settlement contract shall
				contain the following:
7.5.a. A provision that the
				viatical settlement provider will effect the transfer of the amount of the death
				benefit only to the extent or portion of the amount viaticated. The contract shall
				provide that benefits in excess of the amount viaticated shall be paid directly to
				the viator's beneficiary by the insurance company.
7.5.b. A provision that the viatical settlement
				provider will, upon acknowledgment of the completion of the transfer by the
				insurance company, either;
7.5.b.1. Advise the
				viator, in writing, that the insurance company has confirmed the viator's interest
				in the policy; or
7.5.b.2. Send a copy
				of the instrument sent from the insurance company to the viatical settlement
				provider that acknowledges the viator's interest in the policy.
7.5.c. A provision that apportions the premiums to
				be paid by the viatical settlement provider and the viator, provided that the
				contract provides premium payment terms and nonforfeiture options no less favorable,
				on a proportional basis, than those included in the policy.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-8 - Contracts and Payment of Proceeds

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Every
				viatical settlement provider shall file for approval with the Commissioner each
				contract form, application form, brochure and disclosure state form pursuant to W.
				Va. Code §
									33-13C-5.
8.2. In addition to the requirements in W. Va.
				Code §
									33-13C-10, every
				contract shall include the following provisions:
8.2.a. If the viator elects the right to rescind
				the contract, the provider's rights or interest in the policy will terminate
				immediately upon the viator giving notice of the rescission and tendering of the
				settlement proceeds together with any escrow interest received by the
				viator.
8.2.b. The amount of the fee or
				fees to be paid by the viator to the provider in conjunction with the contract shall
				be clearly stated, along with any conditions of payment or receipt of the fee or
				fees.
8.2.c. The contract together with
				the application constitutes the entire agreement between the parties.
8.2.d. If the contract provides for the payment of
				an additional settlement amount to the viator upon the exercise of a guaranteed
				insurability option by the viator, the contract shall disclose the amount of the
				additional settlement and the terms upon which it shall be payable.
8.2.e. If the policy to be viaticated provides a
				guaranteed insurability option, the option may only be exercised for the benefit of
				a person who has an insurable interest in the life to be insured.
8.2.f. The viatical settlement provider shall
				instruct the viator to send the executed documents required to effect the change in
				ownership, assignment or change in beneficiary directly to the escrow agent. Upon
				the escrow agent's receipt of the acknowledgment of the properly completed transfer
				of ownership, assignment or designation of beneficiary from the insurance company,
				the escrow agent shall pay the settlement proceeds to the viator, broker and any
				other persons pursuant to the viatical settlement contract and the escrow agreement.
				The escrow agent shall make payment within three business days of the date the
				escrow agent received the acknowledged forms from the insurance company.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-9 - Advertising and Marketing

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. A viatical
				settlement provider may not use any advertising directed at prospective viators
				unless filed with the Commissioner: Provided, That this requirement is met if the
				advertising used is substantially similar to the sample advertising filed with the
				application for a license or for a renewal of such license and the provider retains
				copies of all advertising for five years after last use and is able to provide
				access to such copies to the Commissioner upon request. Marketing materials directed
				at brokers, financial advisors and persons other than prospective viators do not
				have to be filed with the Commissioner prior to use.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-10 - Disclosures

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. The provider, upon
				receipt of a completed application to viaticate and after determining the value to
				be offered in return for the assignment or transfer of the death benefit or
				ownership of a policy to the provider, shall deliver a proposal to the viator no
				later than the date the contract for a viatical settlement contract is to be signed.
				The proposal shall disclose the following information:
10.1.a. Amount of death benefit to be
				viaticated;
10.1.b. Policy cash value
				before deducting any loan;
10.1.c.
				Policy net cash value after deducting any loan;
10.1.d. Policy death benefit less net cash
				value;
10.1.e. Amount offered to
				viator;
10.1.f. Whether any supplemental
				benefit or benefits are present, will be continued and, if so, the source of premium
				payment and the beneficiary of the proceeds of such supplemental benefit, and the
				provider's interest in each benefit for the following:
10.1.f.1. Accidental death and dismemberment
				benefit, including the amount of the benefit;
10.1.f.2. Disability income;
10.1.f.3. Waiver of premium or of monthly
				deduction waiver;
10.1.f.4. Guaranteed
				insurability options; or
10.1.f.5.
				Children or spouse coverage;
10.1.g. Name of the insurer, and whether the
				insurer does or does not have an accelerated death benefit program for which the
				viator qualifies; and
10.1.h. That an
				escrow agent shall provide escrow services to the parties pursuant to a written
				agreement, signed by the viatical settlement provider, the viatical settlement
				broker and the viator. All persons to receive any form of compensation under the
				escrow agreement shall be clearly identified, including name, business address,
				telephone number and tax identification number.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-11 - Prohibited Practices

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. A viatical
				settlement provider or viatical settlement broker shall obtain from a person that is
				provided with patient identifying information a signed affirmation that the person
				or entity will not further divulge the information without procuring the express,
				written consent of the insured for the disclosure. Notwithstanding the foregoing, if
				a viatical settlement provider or viatical settlement broker is served with a
				subpoena and, therefore, compelled to produce records containing patient identifying
				information, it shall notify the viator and the insured in writing at their last
				known addresses within five business days after receiving notice of the
				subpoena.
11.2. A viatical settlement
				provider may not act also as a viatical settlement broker, whether entitled to
				collect a fee directly or indirectly, in the same viatical settlement
				contract.
11.3. A viatical settlement
				broker shall not, without the written agreement of the viator obtained prior to
				performing any services in connection with a viatical settlement contract, seek or
				obtain any compensation from the viator.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-12 - Insurance Company Practices

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Life insurance
				companies licensed to do business in this state shall respond to a request for
				verification of coverage from a viatical settlement provider or a viatical
				settlement broker within thirty calendar days of the date a request is received,
				subject to the following conditions:
12.1.a. An
				authorization or release signed by the policy owner or certificate holder,
				accompanies the request; and
12.1.b. In
				the case of an individual policy or group insurance coverage where details with
				respect to the certificate holder's coverage are maintained by the insurer,
				submission of a form substantially similar to the format prescribed by the National
				Association of Insurance Commissioners available on the Insurance Commission
				website, which has been completed by the viatical settlement provider or the
				viatical settlement broker in accordance with the instructions on the
				form.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-82 - Military Sales Practices › Section 114-82-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				applies only to the solicitation or sale of any life insurance or annuity product by
				an insurer or insurance producer to an active duty service member of the United
				States Armed Forces.
a. The purpose of this rule is
				to set forth standards to protect active duty service members of the United States
				Armed Forces from dishonest and predatory insurance sales practices by declaring
				certain identified practices to be false, misleading, deceptive or unfair.
b. Nothing herein shall be construed to create or
				imply a private cause of action for a violation of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-82 - Military Sales Practices › Section 114-82-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Active duty" means
				full-time service in the United States Armed Forces and includes members of the
				reserve component (National Guard and Reserve) while serving under published orders
				for active duty or full-time training. The term does not include members of the
				reserve component who are performing active duty or active duty for training under
				military calls or orders specifying periods of less than thirty-one (31) calendar
				days.
2.2. "Department of Defense (DoD)
				personnel" means all active duty service members and all civilian employees,
				including nonappropriated fund employees and special government employees, of the
				Department of Defense.
2.3. "Door to
				door" means a solicitation or sales method whereby an insurance producer proceeds
				randomly or selectively from household to household without prior specific
				appointment.
2.4. "General
				advertisement" means an advertisement having as its sole purpose the promotion of
				the reader's or viewer's interest in the concept of insurance or the promotion of
				the insurer or the insurance producer.
2.5. "Insurer" means an insurance company required
				to be licensed under the laws of this state to provide life insurance products,
				including annuities.
2.6. "Insurance
				producer" means a person required to be licensed under the laws of this state to
				sell, solicit or negotiate life insurance, including annuities.
2.7. "Known" or "Knowingly" means, depending on
				its use herein, the insurance producer or insurer had actual awareness, or in the
				exercise of ordinary care should have known, at the time of the act or practice
				complained of, that the person solicited:
a. Is a
				service member; or
b. Is a service
				member with a pay grade of E-4 or below.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-82 - Military Sales Practices › Section 114-82-3 - Exemptions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. This rule does not
				apply to solicitations or sales involving:
a.
				Credit insurance;
b. Group life
				insurance or group annuities where there is no in-person, face-to-face solicitation
				of individuals by an insurance producer or where the contract or certificate does
				not include a side fund;
c. An
				application to the insurer that issued the existing policy or contract when a
				contractual change or a conversion privilege is being exercised, when the existing
				policy or contract is being replaced by the same insurer pursuant to a program filed
				with and approved by the Insurance Commissioner or when a term conversion privilege
				is exercised among corporate affiliates;
d. Individual stand-alone health policies,
				including disability income policies;
e.
				Contracts offered by Servicemembers' Group Life Insurance (SGLI) or Veterans' Group
				Life Insurance (VGLI), as authorized by 38 U.S.C. Section 1965
et
				seq
.;
f. Life insurance
				contracts offered through or by a non-profit military association, qualifying under
				Section 501 (c) (23) of the Internal Revenue Code (IRC), and which are not
				underwritten by an insurer; or
g.
				Contracts used to fund:
1. An employee pension or
				welfare benefit plan that is covered by the Employee Retirement and Income Security
				Act (ERISA);
2. A plan described by
				Sections 401(a), 401(k), 403(b), 408(k) or 408(p) of the IRC, as amended, if
				established or maintained by an employer;
3. A government or church plan defined in Section
				414 of the IRC, a government or church welfare benefit plan, or a deferred
				compensation plan of a state or local government or tax exempt organization under
				Section 457 of the IRC;
4. A
				nonqualified deferred compensation arrangement established or maintained by an
				employer or plan sponsor;
5. Settlements
				of or assumptions of liabilities associated with personal injury litigation or any
				dispute or claim resolution process; or
6. Prearranged funeral contracts.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-82 - Military Sales Practices › Section 114-82-4 - Practices Declared False, Misleading, Deceptive or Unfair on a Military Installation

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The following acts
				or practices, when committed on a military installation by an insurer or insurance
				producer with respect to the in-person, face-to-face solicitation of life insurance,
				are declared to be false, misleading, deceptive or unfair:
a. Knowingly soliciting the purchase of any life
				insurance product "door to door" or without first establishing a specific
				appointment for each meeting with the prospective purchaser;
b. Soliciting service members in a group or "mass"
				audience or in a "captive" audience where attendance is not voluntary;
c. Knowingly making appointments with or
				soliciting service members during their normally scheduled duty hours;
d. Making appointments with or soliciting service
				members in barracks, day rooms, unit areas, or transient personnel housing or other
				areas where the installation commander has prohibited solicitation;
e. Soliciting the sale of life insurance without
				first obtaining permission from the installation commander or the commander's
				designee;
f. Posting unauthorized
				bulletins, notices or advertisements;
g.
				Failing to present DD Form 2885,
Personal Commercial Solicitation
				Evaluation
, to service members solicited or encouraging service members
				solicited not to complete or submit a DD Form 2885; or
h. Knowingly accepting an application for life
				insurance or issuing a policy of life insurance on the life of an enlisted member of
				the United States Armed Forces without first obtaining for the insurer's files a
				completed copy of any required form which confirms that the applicant has received
				counseling or fulfilled any other similar requirement for the sale of life insurance
				established by regulations, directives or rules of the DoD or any branch of the
				United States Armed Forces.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations › Section 114-83-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to implement W. Va. Code §33-15E,
et
				seq
. relating to Discount Medical Plan Organizations and Discount
				Prescription Drug Plan Organizations. This rule establishes standards to protect
				consumers from unfair or deceptive marketing, licensing requirements and disclosures
				to be made to plan members.
1.2.
				Authority. -- W. Va. Code §§
									33-2-10,
				33-15E-4(b)
				and
				33-15E-17.
1.3. Filing Date. -- May 14, 2009.
1.4. Effective Date. -- May 14, 2009.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations › Section 114-83-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Discount medical
				plan organization" means an entity that contracts with providers, provider networks
				or other discount medical plan organizations to offer access to medical or ancillary
				services at a discount to plan members, provides access for discount medical plan
				members to the services in exchange for fees, dues, charges or other consideration,
				and determines the charges to plan members.
2.2. "Discount prescription drug plan
				organization" means an entity that contracts with providers, pharmacy networks or
				other discount prescription drug plan organizations to offer access to pharmacy
				services to plan members at a discount, provides access for discount prescription
				drug plan members to the services in exchange for fees, dues, charges or other
				consideration, and determines the charges to plan members.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations › Section 114-83-3 - Licensing and Renewal Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. All
				Discount Medical Plan Organizations must obtain a license pursuant to W. Va. Code
				§
									33-15E-4 and
				this rule to continue conducting business and prior to commencing operations in the
				state of West Virginia.
3.2. A person or
				entity must submit the following to obtain a license to conduct business as a
				Discount Medical Plan Organization:
3.2.a. A fully
				completed Discount Medical Plan Organization Application for License (Form
				DMP-1);
3.2.b. A $300 non-refundable
				application fee;
3.2.c. An original
				certificate of authority from the state of domicile;
3.2.d. Copies of all registration documents and
				licenses required by the State of West Virginia;
3.2.e. Articles of Incorporation and
				by-laws;
3.2.f. A description of the
				proposed method of marketing, including types of discounts to be offered and the
				advertising media to be used, including the procedures in place to approve
				advertising, prior to use;
3.2.g. An
				audited financial statement prepared in accordance with generally accepted
				accounting principals certified by an independent certified public accountant,
				including the balance sheet, income statement and statement of changes in cash flow
				for the preceding year or if an affiliate of a parent entity that is publicly
				traded, those audited financial statements and a written guarantee that the minimum
				capital as set forth in W. Va. Code §
										33-15E-5
				will be met by the parent entity;
3.2.h.
				List of names, official positions and addresses of all persons responsible for the
				conduct of the organization's affairs, including company officers, directors and
				shareholders owning ten percent or more shares in the organization;
3.2.i. The number of discount medical plan members
				in the state;
3.2.j. A copy of the form
				of all provider agreements offering medical or ancillary services to its
				members;
3.2.k. A list of all
				participating pharmacies offering discounts on prescription drugs to plan members or
				an Internet website address where such a list can be accessed by the
				Commissioner;
3.2.l. Organization chart
				including all entities within the ultimate parent company structure, if
				applicable;
3.2.m. Biographical
				affidavits for company officers, directors and shareholders owning ten percent or
				more shares in the organization;
3.2.n.
				Proof of compliance with the net worth requirement of $150,000; and
3.2.o. A surety bond in an amount not less than
				$35,000 for the benefit of any person that is damaged by any violation of W. Va.
				Code §33-15E,
et seq.
and this rule.
3.2.p. A description of the member complaint
				procedures.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations › Section 114-83-4 - Marketing Restrictions

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Upon
				request, the Discount Medical Plan Organization or Discount Prescription Drug Plan
				Organization shall submit to the Commissioner all advertising, marketing materials
				and brochures regarding a discount medical plan.
4.2.
4.2.a. All
				advertisements, marketing materials, brochures, discount medical plan cards and any
				other communications of a Discount Medical Plan Organization or Discount
				Prescription Drug Plan Organization that are provided to prospective members and
				members shall be truthful and not misleading in fact or in implication.
4.2.b. An advertisement, any marketing material,
				brochure, discount medical plan card or other communication is misleading in fact or
				in implication if it has a capacity or tendency to mislead or deceive based on the
				overall impression that it is reasonably expected to create within the segment of
				the public to which it is directed.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations › Section 114-83-5 - Disclosure Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
5.1.a. Each Discount Medical Plan Organization
				shall make the following general disclosures, in writing not less than twelve-point
				font, on the first content page of any advertisements, marketing materials or
				brochures made available to the public relating to a discount medical plan and along
				with any enrollment forms given to a prospective member:
5.1.a.1. That the plan is a discount plan and is
				not insurance coverage;
5.1.a.2. That
				the range of discounts for medical or ancillary services provided under the plan
				will vary depending on the type of provider and medical or ancillary service
				received;
5.1.a.3. That the plan does
				not make payments to providers for the medical or ancillary services received under
				the discount medical plan;
5.1.a.4. That
				the plan member is obligated to pay for all medical or ancillary services, but will
				receive a discount from those providers that have contracted with the Discount
				Medical Plan Organization; and
5.1.a.5.
				The toll-free telephone number and Internet website address for the licensed
				Discount Medical Plan Organization for prospective members to obtain additional
				information about and assistance on the discount medical plan and up-to-date lists
				of providers participating in the discount medical plan.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations › Section 114-83-6 - Bundled Products

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. W. Va. Code
				§
									33-15E-8(c)
				recognizes that the discount medical plan may be combined together with other
				products. The bundled product shall clearly identify the discount medical plan
				component separately from each other component. The Discount Medical Plan
				Organization must (i) provide the charges for each discount medical plan in writing
				to the member or (ii) reimburse the member for periodic charges on both the discount
				medical plan and any other product if the member chooses to cancel plan
				membership.
6.2. Any health carrier that
				provides a discount medical plan product that is incidental to the insured product
				is not subject to this section. For the purposes of this subsection, "incidental"
				means costing less than ten percent of the cost of the insured product.
6.3. If a marketer or Discount Medical Plan
				Organization and Discount Prescription Drug Plan Organization solicits, markets or
				sells a discount plan together with any insurance product, the marketer or
				organization shall disclose clearly or conspicuously that the plan is not
				insurance.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-83 - Discount Medical Plan Organizations And Discount Prescription Drug Plan Organizations › Section 114-83-7 - Discount Prescription Drug Plan Organizations

Current through Register Vol. XLI, No. 28, July 12, 2024
A Discount Prescription Drug Plan Organization shall annually
				  submit to the Commissioner a list of all the participating pharmacies offering
				  discounts on prescription drugs to plan members, or an Internet website address
				  where such a list can be accessed by the Commissioner.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				establishes procedures for the licensing and regulation of professional employer
				organizations ("PEOs") doing business in the State of West Virginia.
1.2. Authority. -- W. Va. Code §§
									33-46A-7 and
				33-46A-10.
1.3. Filing Date. -- May 10, 2011.
1.4. Effective Date. -- May 10, 2011.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
In addition to the definitions set forth in W. Va. Code §
									33-46A-2, the following
				  definitions apply:
2.1. "Controlling
				Person" means an officer or director of a corporation operating as a professional
				employer organization, a shareholder holding twenty-five percent (25%) or more of
				the voting stock of a corporation operating as a professional employer organization,
				or a person or partner that possesses, directly or indirectly, the power to direct
				or cause the direction of the management or policies of a company or partnership
				operating as a professional employer organization, or a person that possesses,
				directly or indirectly, the power to direct or cause the direction of the management
				or policies of a company operating as a professional employer organization through
				the ownership of voting securities, by contract or otherwise, and who is actively
				involved in the day-to-day management of the company.
2.2. "PEO" means a professional employer
				organization as defined in W. Va. Code §
									33-46A-2(g).
2.3. "Temporary Help Services" means services
				consisting of a person:
2.3.a. Recruiting and
				hiring his, her or its own employees;
2.3.b. Finding other organizations that need the
				services of those employees;
2.3.c.
				Assigning those employees to perform work at or services for the other organizations
				to support or supplement the other organizations' workforces, or to provide
				assistance in special work situations such as, but not limited to, employee
				absences, skill shortages, seasonal workloads, or to perform special assignments or
				projects, and
2.3.d. Customarily
				attempting to reassign the employees to other organizations when they finish each
				assignment.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-4 - Combined or Consolidated Licenses

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				PEOs in a PEO group may satisfy the financial and reporting requirements of W. Va.
				Code §33-46A on a combined or consolidated basis by filing a combined or
				consolidated application for a license of multiple PEOs majority-owned by the same
				parent, entity or persons and may do so on forms prescribed and approved by the
				Commissioner.
4.1.a. A subsidiary corporation may
				submit with its license application the combined or consolidated financial statement
				of its parent corporation in lieu of its own along with a parental
				guarantee.
4.1.b. Multiple PEOs may only
				file reports and meet financial requirements on a combined or consolidated basis if
				each company that is part of the multiple employer organization group provides a
				guarantee of the obligations of W. Va. Code §
										33-46A-1 et seq. of
				each other member of the group.
4.1.c.
				Such a guarantee may be in the form of an indemnification agreement or a resolution
				of the board of directors of the parent company authorizing the guarantee of
				workers' compensation, unemployment tax liabilities and other obligations of a
				subsidiary PEO in the combined or consolidated license.
4.1.d. Each PEO involved in a combined or
				consolidated license must pay a separate application fee.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-5 - Limited Licenses

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The
				Commissioner may, under terms he or she determines appropriate, grant a limited
				license to a PEO. An applicant for a limited license must demonstrate at a minimum
				that it is licensed or registered as a PEO in another state under terms that are
				substantially similar to those required by this state, that it does not maintain an
				office in this state or directly solicit employers located in this state, and that
				it does not have more than fifty (50) covered employees in this state on any given
				day.
5.2. In addition to the showing
				required by subsection 5.1 of this section, an applicant for a limited license shall
				complete an application on forms prescribed and approved by the Commissioner. Proof
				of financial responsibility shall be in the amount and form determined appropriate
				by the Commissioner.
5.3. Each
				application for a limited license shall be accompanied by an application fee of
				$200.
5.4. Any incomplete application,
				as determined by the Commissioner, that remains incomplete for a period of four (4)
				months from the date of notice from the Commissioner that the application is
				incomplete will be considered withdrawn and new application and application fees
				will be required. An existing license, not suspended, revoked or otherwise limited
				by the Commissioner, shall remain in effect during the review of a renewal
				application by the Commissioner.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-6 - Denial of a License Application or Renewal

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The Commissioner may deny an application for
				license:
6.1.a. Where the application is not fully
				completed, improperly executed or otherwise deficient on its face;
6.1.b. Where documents required to supplement the
				application are not included in the application packet;
6.1.c. Where any fee required by sections 3, 4 or
				5 of this rule and W. Va. Code §
										33-46A-4 is not
				submitted;
6.1.d. Where the applicant
				has had a PEO license revoked in this or any other state, unless such revocation has
				subsequently been rescinded or otherwise suspended and the problems remedied to the
				reasonable satisfaction of the Commissioner;
6.1.e. Where the applicant, or any person named in
				the application, has made a material misrepresentation in the application;
				or
6.1.f. Upon finding that any person
				named in the application, any controlling person or any person in a management or
				policy-making position with any applicant, is not of good moral character, business
				integrity or financial responsibility, or that there is good and sufficient reason
				within the meaning and purpose of this rule or of W. Va. Code §
										33-46A-1 et seq. to
				deny the application.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-7 - Suspension, Revocation or Probation of a License

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. If a PEO fails to comply with any of the
				requirements for a license or renewal of a license, the Commissioner may suspend or
				revoke the license or place the PEO on probation until such time the PEO comes into
				compliance with the licensing requirements.
7.2. The Commissioner may suspend or revoke the
				license of a PEO or place a PEO on probation for a violation of any provision of
				this rule, W. Va. Code §
									33-46A-1
et
				seq
., any order of the Commissioner or any law relating to the conduct of
				the business of the PEO.
7.3. In
				determining an appropriate sanction, the Commissioner may consider the following:
7.3.a. The record of previous violations by the
				PEO;
7.3.b. The significance or scale of
				the violation;
7.3.c. The existence of
				outstanding reports or failures to pay;
7.3.d. Failure to respond to a request to produce
				records, documents or proof of payment;
7.3.e. Submission of falsified or altered records,
				forms, documents or proof of payment;
7.3.f. Whether the violations were willful or
				knowing; and
7.3.g. Good faith efforts
				by the PEO to remedy any violations.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-8 - Investigations

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. The Commissioner
				may request information, perform an investigation and audit and review documents
				necessary to determine whether a PEO has violated any provision of W. Va. Code
				§
									33-46A-1
et
				seq.
or this rule. In conducting an investigation of a PEO, the
				Commissioner or his or her representatives may enter the business premises during
				reasonable business hours and may examine and copy records pertinent to the
				investigation in accordance with the provisions of W. Va. Code §
									33-2-9.
8.2. An applicant or licensed PEO shall respond to
				any requests for information and comply with any investigations that are initiated
				by the Commissioner. Information gathered pursuant to an investigation is
				confidential and not open to public inspection pursuant to W. Va. Code §
									33-46A-5.
8.3. The Commissioner may charge the licensee the
				actual cost of any investigation undertaken at the direction of the
				Commissioner.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-9 - Complaints

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Any person may file
				a written complaint with the Commissioner regarding a PEO. The Commissioner shall
				receive any complaints and shall investigate and determine whether action is
				necessary involving allegations of any misconduct as provided in W. Va. Code §
									33-46A-8 and
				this rule. The complainant, the PEO and the nature of the alleged misconduct and the
				circumstances surrounding it shall be clearly identified, and supporting
				documentation shall be attached.
9.2.
				The Commissioner shall mail a copy of the complaint to the PEO in question and
				request a written response.
9.3. If a
				PEO fails to respond within thirty (30) days to a request made pursuant to
				subsection 9.2 of this section or to a request for information during an
				investigation, the Commissioner may take action pursuant to W. Va. Code §
									33-46A-8.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-10 - Responsibilities of a Professional Employer Organization

Current through Register Vol. XLI, No. 28, July 12, 2024
An applicant or licensed PEO shall notify the Commissioner in
				  writing within ten (10) days of any of the following:
10.1. Conviction, judgment, guilty plea or no
				contest plea of the applicant or any of the applicant's controlling persons for any
				violation listed in W. Va. Code §
									33-46A-8.
10.2. Final action by a state or federal
				regulatory agency for violations related to the operation of a PEO;
10.3. Determination of any court of competent
				jurisdiction, including federal courts, located in any state, that the applicant or
				any of the applicant's controlling persons were found, or pled guilty to fraud
				related to the operation of a PEO; or
10.4. PEO's failure to stay current with
				obligations that relate to payroll, payroll related taxes, workers' compensation
				insurance premiums for covered employees and employee benefits.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-11 - Notification of Change in Identifying Information

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. Each PEO has a continuing duty to timely
				notify the Commissioner, in a format and manner prescribed by the Commissioner, of
				changes in its identifying information provided pursuant to subdivisions c through
				h, inclusive, of subsection 3.2 of this rule.
11.2. Failure by a PEO to timely notify the
				Commissioner of a change in this information shall subject the PEO to the penalties
				provided in W. Va. Code §
									33-46A-8 and
				section 7 of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-85 - Professional Employer Organizations › Section 114-85-12 - Enforcement and penalties

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. If the
				Commissioner finds that any licensed PEO has violated any provisions of this rule or
				any provisions in W. Va. Code §
									33-46A-1 et seq.,
				the Commissioner may, in lieu of a suspension or revocation, order the PEO to pay a
				penalty in a sum not to exceed $10,000. If the PEO fails to pay the penalty within
				thirty days after notice of the penalty, the Commissioner may revoke or suspend the
				license of the PEO.
12.2. With respect
				to any person operating as a PEO without a license, the Commissioner may, pursuant
				to W. Va. Code §
									33-46A-4 a(a),
				do one or more of the following:
12.2.a. File a
				complaint in the Circuit Court of Kanawha County or in any county in which illegal
				PEO activities are alleged to have occurred to enjoin the person from engaging in
				any act that constitutes a PEO service; and
12.2.b. After notice and hearing in accordance
				with W. Va. Code §
										33-2-13, assess restitution
				in an amount sufficient to reimburse any person adversely affected by the operation
				of the unlicensed PEO and, in addition to or in lieu of restitution, impose a fine
				in a sum not to exceed $20,000 for each unauthorized act.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-86 - Preneed Life Insurance Minimum Standards For Determining Reserve Liabilities And Nonforfeiture Values › Section 114-86-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				establishes minimum mortality standards to be used in determining reserve and
				nonforfeiture values for insurance policies used to fund preneed funeral contracts.
				This rule is based on the National Association of Insurance Commissioners' "Preneed
				Life Insurance Minimum Standards for Determining Reserve Liabilities and
				Nonforfeiture Values Model Regulation" (Model 817) adopted in March, 2008.
1.2. Authority. -- W. Va. Code §
									33-2-10.
1.3. Filing Date. -- May 14, 2009.
1.4. Effective Date. -- May 14, 2009.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-86 - Preneed Life Insurance Minimum Standards For Determining Reserve Liabilities And Nonforfeiture Values › Section 114-86-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "2001 CSO Mortality
				Table" means that mortality table, consisting of separate rates of mortality for
				male and female lives, developed by the American Academy of Actuaries Commissioner's
				Standard Ordinary ("CSO") Task Force from the Valuation Basic Mortality Table
				developed by the Society of Actuaries Individual Life Insurance Valuation Mortality
				Task Force and set forth in W. Va. Code of St. R. §114 CSR 69. Unless the
				context indicates otherwise, the "2001 CSO Mortality Table" includes both the
				ultimate form of that table and the select and ultimate form of that table, and
				includes both the smoker and nonsmoker mortality tables and the composite mortality
				tables. It also includes both the age-nearest-birthday and age-last-birthday bases
				of the mortality tables.
2.2. "Preneed
				funeral contract" means any contract that is financed by the purchase of an
				insurance policy or annuity under which a person promises to furnish or make
				available funeral services, funeral goods or burial goods for use at a time
				determinable by the death of the contract beneficiary who is either named or implied
				therein.
2.3. "Preneed insurance policy"
				means a life insurance policy, annuity contract or other insurance contract issued
				by an insurance company which, whether by assignment or otherwise, has for its
				purpose the funding of a preneed funeral contract.
2.4. "Ultimate 1980 CSO" means the National
				Association of Insurance Commissioners' 1980 standard ordinary mortality table (1980
				CSO Table), without ten-year selection mortality factors, incorporated into the 1980
				amendments to the NAIC Standard Valuation Law and referenced in W. Va. Code §
									33-7-9(d)(1)(C).
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-86 - Preneed Life Insurance Minimum Standards For Determining Reserve Liabilities And Nonforfeiture Values › Section 114-86-3 - Minimum Valuation Mortality Standards

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. For
				preneed insurance contracts, the minimum mortality standard for determining reserve
				liabilities and nonforfeiture values for both male and female insureds is the
				Ultimate 1980 CSO.