reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-54 - Group Accident And Sickness Insurance Issuance, Portability And marketing Requirements › Section 114-54-4 - Application of Creditable Coverage to Reduce Preexisting Condition Exclusion Period

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. For purposes of
				reducing any preexisting condition exclusion period under terms of a health benefit
				plan, a health insurer shall take into account all information that it obtains or
				that is presented on behalf of an individual to determine, based on relevant facts
				and circumstances, whether an individual has creditable coverage and is entitled to
				offset all or a portion of any preexisting condition exclusion.
4.2. For purposes of reducing any preexisting
				condition exclusion period under terms of a health benefit plan, a health insurer
				may elect to determine an individual's days of creditable coverage:
a. By the standard method described in subsection
				4.3;
b. Subject to other applicable
				requirements, in any other manner that is at least as favorable to the individual as
				the standard method described in subsection 4.3; or
c. By the alternative method described in
				subsection 4.4 with respect to any or all categories of benefits described in
				subsection 4.4.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-54 - Group Accident And Sickness Insurance Issuance, Portability And marketing Requirements › Section 114-54-5 - Certification of Creditable Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. A
				health insurer shall furnish information as provided in this section, without
				charge, for individuals covered under a health benefit plan (including a health
				benefit plan issued in connection with an entity or program, other than a group
				health plan, for which certificates are required, as provided in rules governing the
				entity or program) except to the extent that:
a.
				Coverage was provided by another party;
b. Another party agrees to provide information
				regarding coverage provided by the health insurer and actually provides a
				certificate of creditable coverage including all information required under
				subsection 5.4 of this section; or
c.
				Coverage consisted of excepted benefits, but the health insurer may be required to
				disclose information concerning the benefits to another group health plan or health
				insurer that uses the alternative method of counting creditable coverage and
				provides coverage to an individual previously covered by the first health
				insurer.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-54 - Group Accident And Sickness Insurance Issuance, Portability And marketing Requirements › Section 114-54-7 - Prohibition Against Discrimination Based on a Health Status-Related Factor

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. A health insurer
				may not establish rules for eligibility, including continued eligibility, of any
				individual to enroll under the terms of the group health plan based on a health
				status-related factor in relation to the individual or a dependent of the
				individual:
a. Rules for eligibility to enroll
				include rules defining any applicable waiting or affiliation period and rules
				relating to late and special enrollment; and
b. This section does not:
1. Require a health insurer to provide particular
				benefits other than those provided under the terms of the group health plan or
				health benefit plan; or
2. Prevent a
				health insurer from establishing limitations or restrictions on the amount, level,
				extent or nature of the benefits or coverage for similarly situated individuals
				enrolled in the plan or coverage.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-54 - Group Accident And Sickness Insurance Issuance, Portability And marketing Requirements › Section 114-54-8 - Special Enrollment Periods

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. A health
				insurer shall permit individuals to enroll for coverage under terms of a health
				benefit plan, without regard to other enrollment dates permitted under the group
				health plan, if an eligible employee requests enrollment for himself or herself or,
				if the group health plan makes coverage available to dependents, on behalf of a
				dependent who is eligible but not enrolled under the group health plan, during the
				special enrollment period, which shall be (30) thirty days following an event
				described in subsections 8.2 or 8.3 with respect to the individual for whom
				enrollment is requested. A health insurer may impose enrollment requirements that
				are otherwise applicable under terms of the group health plan to individuals
				requesting immediate enrollment.
8.2. An
				individual, who previously had other coverage for medical care and for whom an
				eligible employee declined coverage under the group health plan, may be enrolled
				during a special enrollment period if the individual has lost the other coverage for
				medical care and:
a. If required by the group
				health plan, the eligible employee stated in writing when declining the coverage,
				after being given a notice of the requirement for, and the consequences of failure
				to submit, a written statement, that coverage was declined because the individual
				had coverage for medical care under another group health plan or otherwise; and
b. When enrollment was declined for the
				individual:
1. The individual had coverage under a
				COBRA continuation provision, as defined in W. Va. Code '33-15-2a(c),
				and the coverage has been exhausted; or
2. The individual had coverage other than under a
				COBRA continuation provision and the coverage has been terminated due to loss of
				eligibility for the coverage, including loss of coverage as a result of legal
				separation, divorce, death, termination of employment, reduction in the number of
				hours of employment and any loss of eligibility after a period that is measured by
				reference to any of the foregoing, or termination of employer contributions towards
				the other coverage. For purposes of this paragraph:
A. Loss of eligibility for the coverage does not
				include loss of eligibility due to the eligible employee's or dependent's failure to
				make timely premium payments or termination of coverage for cause such as making a
				fraudulent claim or intentional misrepresentation of material fact in connection
				with the group health plan; and
B.
				Employer contributions include contributions by any current or former employer of
				the individual or another person that was contributing to coverage for the
				individual.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-54 - Group Accident And Sickness Insurance Issuance, Portability And marketing Requirements › Section 114-54-9 - Guaranteed Availability for Small Employers

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Except as provided in subsections 9.2 through
				9.5, a health insurer that offers health benefit plans to small employers in this
				state shall:
a. Offer to any small employer in
				this state all health benefit plans that are approved for sale to small employers
				and that the health insurer is actively marketing;
b. Accept any small employer that applies for any
				health benefit plan approved for sale to small employers and actively marketed by
				the health insurer; and
c. Under a
				health benefit plan issued to a small employer, accept for enrollment every
				individual who is eligible:
1. To enroll under the
				health benefit plan in accordance with terms of the group health plan in connection
				with which the health benefit plan is issued;
2. For coverage under rules of the health insurer
				that are uniformly applicable in this state to small employers to which the health
				insurer offers health benefit plans; and
3. For coverage in accordance with W. Va. Code
				chapter thirty-three, and other applicable law;
d. With respect to an individual who meets the
				requirements of paragraphs 1 through 3 of subdivision c of subsection 9.1, a health
				insurer:
1. Shall accept the individual for
				enrollment during the period in which he or she first becomes eligible to enroll
				under terms of the group health plan, or during a special enrollment period;
				and
2. May not impose any restriction
				inconsistent with section seven of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-54 - Group Accident And Sickness Insurance Issuance, Portability And marketing Requirements › Section 114-54-10 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of this legislative rule or the application
				  thereof to any person or circumstance is for any reason held invalid, the remainder
				  of the rule and the application of the provision to other persons or circumstances
				  shall not be affected by the holding.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance › Section 114-55-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to set forth guidelines for insurers required to provide
				accident and sickness insurance coverage to eligible individuals without the
				imposition of preexisting conditions exclusions, the election of coverage by
				insurers, certification and disclosure of coverage, and dependent coverage in
				accordance with the federal Health Insurance Portability and Accountability Act of
				1996 (HIPAA) and related federal mandates. The requirements set forth in this rule
				apply to accident and sickness insurance coverage, other than excepted benefits,
				offered, sold, issued, renewed or in effect in the individual market after June 30,
				1997, regardless of when a period of creditable coverage occurs.
1.2. Authority. -- W. Va. Code '33-2-10.
1.3. Filing Date. -- April 30, 1999.
1.4. Effective Date. -- April 30, 1999.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance › Section 114-55-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Affiliation
				period" means a period of time that must expire before accident and sickness
				insurance coverage provided by a health maintenance organization becomes effective,
				and during which the health maintenance organization is not required to provide
				benefits.
2.2. "COBRA continuation
				provision" means any of the following:
a. Section
				4980B of the Internal Revenue Code of 1986, other than subsection (f)(1) of such
				section insofar as it relates to pediatric vaccines;
b. Part 6 of Subtitle B of Title I of the Employee
				Retirement Income Security Act of 1974, other than Section 609 of such act; or
c. Title XXII of the Public Health
				Service Act.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance › Section 114-55-3 - Election of Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Except as
				provided in subsection 3.2, an insurer that provides accident and sickness insurance
				coverage in the individual market may not decline to offer coverage or deny
				enrollment under any policy form it actively markets in the individual market to any
				eligible individual who applies for coverage within sixty-three days after
				termination of the individual's prior creditable coverage. An insurer is deemed to
				meet this requirement if, upon the request of an eligible individual, it promptly:
a. Provides information about all available
				coverage options;
b. Enrolls the
				individual in any coverage option the individual selects; and
c. Does not impose any preexisting condition
				exclusion on the individual.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance › Section 114-55-4 - Dependent Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. If an eligible
				individual elects to enroll in individual accident and sickness insurance coverage
				that provides coverage for dependents, the insurer may apply a preexisting condition
				exclusion on any dependent who is not an eligible individual except as otherwise
				provided by this rule.
4.2. A child is
				deemed to be an eligible individual if the following conditions are met:
a. The child was covered under any creditable
				coverage within 30 days of birth, adoption, or placement for adoption; and
b. The child has not had a significant
				break in coverage.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance › Section 114-55-5 - Certification of Creditable Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. A
				certificate of creditable coverage must be provided, without charge, for individuals
				and dependents, who are or were covered under an individual accident and sickness
				insurance policy as follows:
a. An automatic
				certificate must be provided within a reasonable time period consistent with State
				law after the individual ceases to be covered under the policy.
b. A request for a certificate may be made by, or
				on behalf of, an individual within 24 months after coverage ends. After the request
				is received, an insurer must provide the certificate promptly. A certificate must be
				provided even if the individual has previously received an automatic certificate
				under subdivision a of this subsection.
c. An insurer must establish a procedure for
				individuals and dependents to request and receive certificates under subdivision b
				of this subsection.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance › Section 114-55-6 - Determination of an Eligible Individual

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Each insurer offering accident and sickness insurance coverage in the individual
				market is responsible for determining whether an applicant for coverage is an
				eligible individual and must exercise reasonable diligence in making this
				determination in a timely fashion.
a. If an
				insurer determines that an individual is an eligible individual, the insurer must
				promptly issue a policy to that individual.
b. If the information presented in or with an
				application is substantially insufficient for the insurer to make the determination
				described in subsection 6.1, the insurer may immediately request additional
				information from the individual, and must act promptly to make its determination
				after receipt of the requested information.
c. If an entity fails to provide a certificate of
				creditable coverage as required by this section, the insurer is subject to the
				procedures set forth in subsection 5.9 of this rule concerning the individual's
				right to demonstrate creditable coverage.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-55 - Guaranteed Issue Of Individual Accident And Sickness Insurance › Section 114-55-7 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. If any provision of
				this rule or the application of this rule to any person or circumstance is for any
				reason held to be invalid, the remainder of the rule and the application of the
				provisions to other persons or circumstances shall not be affected by the
				holding.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to set forth standards for quality assurance programs
				established as a component of a prepaid limited health service organization's
				overall structure.
1.2. Authority. -- W.
				Va. Code '' 33-2-10, 33-25D-7, and 33-25D-22.
1.3. Filing Date. -- April 24, 2000.
1.4. Effective Date. -- April 24, 2000.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-3 - Goals of a Quality Assurance Program

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The
				goals of a prepaid limited health service organization's quality assurance program
				shall be to:
a. Assure the provision of
				appropriate limited health services delivered to members, while simultaneously
				addressing the effectiveness of quality of care;
b. Monitor, evaluate and improve the quality of
				care for limited health services;
c.
				Provide a systematic process that promotes the delivery of appropriate care in a
				timely, effective and efficient manner, while maintaining the quality of care for
				limited health services
;
d.
				Direct members and providers toward the goal of quality and cost effective care for
				limited health services.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-4 - Requirements of a Quality Assurance Program

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. A prepaid limited health service organization
				shall develop a quality assurance program which adheres to all applicable state and
				federal laws, federal regulations and state rules.
a. If, at any time, the commissioner determines
				that the quality assurance program of the prepaid limited health service
				organization has become deficient in any significant area, the commissioner, in
				addition to other remedies available, may establish a corrective action plan that
				the PLHSO must follow as a condition to the issuance or maintenance of a certificate
				of authority.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-5 - Quality Management & Improvement

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				Organizational arrangements and responsibilities for quality management and
				improvement processes shall be clearly defined and assigned to appropriate
				individuals.
a. There shall be a detailed written
				description of the program which shall be reviewed annually and updated as
				necessary.
b. A senior executive shall
				be responsible for program implementation.
c. A medical director shall be employed by the
				prepaid limited health service organization and have substantial involvement in
				quality improvement activities.
d. A
				committee shall be created to oversee quality improvement and shall include PLHSO
				providers as active participants. The committee shall keep contemporaneous written
				records reflecting all of its actions.
e. The role, structure and function, including
				frequency of meetings, of the quality improvement committee shall be specified in
				the program description.
f. Adequate
				resources including, but not limited to, personnel, analytic capabilities and data
				resources shall be dedicated to meet program needs.
g. A written quality improvement work plan shall
				be prepared annually and shall include: the objectives, scope and planned projects
				or activities for the year; planned monitoring of previously identified issues,
				including tracking of issues over time; and planned evaluation of the quality
				improvement program.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-6 - Utilization Management Program

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. A
				prepaid limited health service organization shall have a documented utilization
				management program which shall include, at a minimum, performance goals, policies
				and procedures to evaluate medical necessity
,
criteria used,
				information sources, and the process used to review and approve the provision of
				limited health services
.
a. The UM program shall have a mechanism for
				evaluating and updating the program description on a periodic basis which shall be
				specified by the prepaid limited health service organization.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-7 - Credentialing & Recredentialing

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. A
				prepaid limited health service organization shall ensure that its network has
				sufficient numbers and types of providers. The PLHSO shall have a written access
				plan outlining its strategy for maintaining an adequate network and shall implement
				mechanisms designed to assure the availability of coordinating providers.
7.2. A prepaid limited health service organization
				shall have written policies and procedures for the credentialing of all providers
				that include the original credentialing, recredentialing, recertification and
				reappointment of providers who fall under its scope of authority and action.
a. The governing body, or the group or individual
				to whom the governing body has formally delegated the credentialing function, shall
				review and approve credentialing policies and procedures.
b. A credentialing committee or other peer review
				body shall be established to make recommendations regarding credentialing decisions.
				The committee shall include providers including, but not limited to, coordinating
				providers and physicians, as voting members.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-8 - Members' Rights & Responsibilities

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. A
				prepaid limited health service organization shall demonstrate a commitment to
				treating members with respect by developing written policies giving them the right
				to:
a. Voice grievances about the PLHSO or care
				provided;
b. Have information concerning
				the PLHSO, its services, the providers providing care and members' rights and
				responsibilities;
c. Participate in
				decision-making regarding limited health services;
d. Be treated with respect and recognition of
				their dignity and need for privacy; and
e. Permit the provider or other person designated
				by the member or a court of competent jurisdiction to make and enforce all health
				care decisions which the member could make if he or she had capacity or were
				competent.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-9 - Preventive Health Services

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. A prepaid
				limited health service organization shall adopt guidelines for the use of preventive
				health services which must be based on reasonable medical evidence and the full
				service population. The guidelines shall be developed or adopted with the
				participation of the PLHSO's providers and must include a mechanism for periodic
				updates.
a. The guidelines and all updates shall
				be provided in writing to all providers and members.
b. Each guideline shall describe the prevention or
				early detection interventions and the recommended frequency and conditions under
				which the interventions are required. The prepaid limited health service
				organization shall document the scientific basis or authority upon which it based
				the preventive health guidelines.
c.
				Providers from the prepaid limited health service organization who have appropriate
				knowledge shall be involved in the adoption of the preventive health
				guidelines.
d. At least annually, a
				PLHSO shall monitor, evaluate and take action upon a minimum of two of the following
				preventive services as appropriate:
1. Infancy,
				childhood and pre-adolescent screening and educational interventions such as
				learning and behavioral problems in preschoolers; child abuse and neglect; and
				impulse disorders;
2. Adolescent
				screening and educational interventions such as depression, acting out, and
				oppositional disorders; eating disorders; alcohol and drug abuse; suicidal ideation;
				and high-risk sexual behavior;
3. Adult
				screening and educational interventions such as mood disorders; obsessive compulsive
				disorders; anxiety disorders; schizophrenia; eating disorders; and alcohol and drug
				abuse including prescription drug dependence;
4. Family and community educational interventions
				such as healthy lifestyle choices; parent training; stress management; dying, loss
				and bereavement; domestic violence; and community resources;
5. Elderly screening and educational interventions
				such as mood disorders; organic brain syndrome; complications from chronic
				illnesses; and substance dependence including prescription drug dependence;
				and
6. Any other preventive services
				deemed appropriate by the commissioner and any other state or federal regulatory
				authorities.
e. Preventive
				health service studies shall be enrollee population-based, measuring compliance as
				it relates to the total at-risk population.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-10 - Treatment records

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. A prepaid
				limited health service organization shall require all of its providers to have an
				organized treatment record keeping system. Treatment records shall be maintained in
				a manner that is current, detailed, organized and permits effective patient care and
				quality review. Records shall also reflect all aspects of patient care including
				general medical services.
a. A PLHSO shall set
				forth in writing appropriate standards for treatment records, the systematic review
				for conformance and the institution of corrective action when standards are not met.
				Copies of all standards and goals and any updates shall be provided to all
				providers
.
b. Records shall
				be available to providers at each patient visit and to nationally and state
				recognized reviewing bodies sanctioned by the commissioner.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations › Section 114-56-11 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. This rule is
				subject to the anti-discrimination provisions of W.Va. Code '
				33-25A-31.
11.2. If any provision of this rule or the
				application of this rule to any person or circumstances is for any reason held to be
				invalid, the remainder of the rule and the application of the provisions to other
				persons or circumstances shall not be affected by the holding.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				governs the treatment of nonpublic personal health information and nonpublic
				personal financial information about individuals by all licensees of the West
				Virginia Insurance Commission.
1.2.
				Authority. -- W. Va. Code §§
									33-2-10,
				33-6F-1 and
				33-11A-4.
a. This rule:
1.
				Requires a licensee to provide notice to individuals about its privacy policies and
				practices;
2. Describes the conditions
				under which a licensee may disclose nonpublic personal health information and
				nonpublic personal financial information about individuals to affiliates and
				nonaffiliated third parties; and
3.
				Provides methods for individuals to prevent a licensee from disclosing that
				information.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Affiliate" means a
				company that controls, is controlled by or is under common control with another
				company.
2.2. "Clear and conspicuous"
				means that a notice is reasonably understandable and designed to call attention to
				the nature and significance of the information in the notice.
a. A licensee makes its notice reasonably
				understandable if it:
1. Presents the information
				in the notice in clear, concise sentences, paragraphs and sections;
2. Uses short explanatory sentences or bullet
				lists whenever possible;
3. Uses
				definite, concrete, everyday words and active voice whenever possible;
4. Avoids multiple negatives;
5. Avoids legal and highly technical business
				terminology whenever possible; and
6.
				Avoids explanations that are imprecise and readily subject to different
				interpretations.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-3 - Initial Privacy Notice to Consumers Required

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. A licensee shall provide a clear and
				conspicuous notice that accurately reflects its privacy policies and practices
				regarding disclosure of nonpublic personal financial information to:
a. An individual who becomes the licensee's
				customer, not later than when the licensee establishes a customer relationship,
				except as provided in subsection 3.5; and
b. A consumer, before the licensee discloses any
				nonpublic personal financial information about the consumer to any nonaffiliated
				third party, if the licensee makes a disclosure other than as authorized by sections
				13 and 14.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-4 - Annual Privacy Notice to Customers Required

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. A licensee shall provide a clear and
				conspicuous notice to customers that accurately reflects its privacy policies and
				practices regarding disclosure of nonpublic personal financial information not less
				than annually during the continuation of the customer relationship. Annually means
				at least once in any period of twelve (12) consecutive months during which that
				relationship exists. A licensee may define the twelve-consecutive-month period, but
				the licensee shall apply it to the customer on a consistent basis.
a. A licensee provides a notice annually if it
				defines the twelve-consecutive-month period as a calendar year and provides the
				annual notice to the customer once in each calendar year following the calendar year
				in which the licensee provided the initial notice. For example, if a customer opens
				an account on any day of year one, the licensee shall provide an annual notice to
				that customer by December 31 of year two.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-5 - Information to be Included in Privacy Notices

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The initial, annual and revised privacy
				notices that a licensee provides under sections 3, 4 and 7 shall include each of the
				following items of information, in addition to any other information the licensee
				wishes to provide, that applies to the licensee and to the consumers to whom the
				licensee sends its privacy notice:
a. The
				categories of nonpublic personal financial information that the licensee
				collects;
b. The categories of nonpublic
				personal financial information that the licensee discloses;
c. The categories of affiliates and nonaffiliated
				third parties to whom the licensee discloses nonpublic personal financial
				information, other than those parties to whom the licensee discloses information
				under sections 13 and 14;
d. The
				categories of nonpublic personal financial information about the licensee's former
				customers that the licensee discloses and the categories of affiliates and
				nonaffiliated third parties to whom the licensee discloses nonpublic personal
				financial information about the licensee's former customers, other than those
				parties to whom the licensee discloses information under sections 13 and
				14;
e. If a licensee discloses nonpublic
				personal financial information to a nonaffiliated third party under section 12 (and
				no other exception in sections 13 and 14 applies to that disclosure), a separate
				description of the categories of information the licensee discloses and the
				categories of third parties with whom the licensee has contracted;
f. An explanation of the consumer's right under
				subsection 9.1 to opt out of the disclosure of nonpublic personal financial
				information to nonaffiliated third parties, including the methods by which the
				consumer may exercise that right at that time;
g. Any disclosures that the licensee makes under
				section 603(d)(2)(A)(iii) of the federal Fair Credit Reporting Act (
				15 U.S.C.
				1681 a(d)(2)(A)(iii)) (that is, notices regarding
				the ability to opt out of disclosures of information among affiliates);
h. The licensee's policies and practices with
				respect to protecting the confidentiality and security of nonpublic personal
				information; and
i. Any disclosure that
				the licensee makes under subsection 5.2 of this section.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-6 - Form of Opt-Out Notice to Consumers and Opt-Out Methods

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. If a licensee is required to provide an
				opt-out notice under subsection 9.1, it shall provide a clear and conspicuous notice
				to each of its consumers that accurately explains the right to opt out under that
				section. The notice shall state:
a. That the
				licensee discloses or reserves the right to disclose nonpublic personal financial
				information about its consumer to a nonaffiliated third party;
b. That the consumer has the right to opt out of
				that disclosure; and
c. A reasonable
				means by which the consumer may exercise the opt-out right.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-7 - Revised Privacy Notices

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Except as
				otherwise authorized in this rule, a licensee shall not, directly or through an
				affiliate, disclose any nonpublic personal financial information about a consumer to
				a nonaffiliated third party other than as described in the initial notice that the
				licensee provided to that consumer under section 3, unless:
a. The licensee has provided to the consumer a
				clear and conspicuous revised notice that accurately describes its policies and
				practices regarding disclosure of nonpublic personal financial
				information;
b. The licensee has
				provided to the consumer a new opt-out notice;
c. The licensee has given the consumer a
				reasonable opportunity, before the licensee discloses the information to the
				nonaffiliated third party, to opt out of the disclosure; and
d. The consumer does not opt out.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-8 - Delivery

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. A licensee shall
				provide any notices that this rule requires so that each consumer can reasonably be
				expected to receive actual notice in writing or, if the consumer agrees,
				electronically.
8.2. A licensee may
				reasonably expect that a consumer will receive actual notice if the licensee:
a. Hand-delivers a printed copy of the notice to
				the consumer;
b. Mails a printed copy of
				the notice to the last known address of the consumer separately, or in a policy,
				billing or other written communication;
c. For a consumer who conducts transactions
				electronically, posts the notice on the electronic site and requires the consumer to
				acknowledge receipt of the notice as a necessary step to obtaining a particular
				insurance product or service; or
d. For
				an isolated transaction with a consumer, such as the licensee providing an insurance
				quote or selling the consumer travel insurance, posts the notice and requires the
				consumer to acknowledge receipt of the notice as a necessary step to obtaining the
				particular insurance product or service.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-9 - Limits on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Except as
				otherwise authorized in this rule, a licensee may not, directly or through any
				affiliate, disclose any nonpublic personal financial information about a consumer to
				a nonaffiliated third party unless:
a. The
				licensee has provided to the consumer an initial notice as required under section
				3;
b. The licensee has provided to the
				consumer an opt-out notice as required in section 6;
c. The licensee has given the consumer a
				reasonable opportunity, before it discloses the information to the nonaffiliated
				third party, to opt out of the disclosure; and
d. The consumer does not opt out.
e. A licensee provides a consumer with a
				reasonable opportunity to opt out if:
1. The
				licensee mails the notices required in subdivisions a and b of this subsection to
				the consumer and allows the consumer to opt out by mailing a form, calling a
				toll-free telephone number, or any other reasonable means, within thirty (30) days
				from the date the licensee mailed the notices.
2. A customer opens an on-line account with a
				licensee and agrees to receive the notices required in subdivisions a and b of this
				subsection electronically, and the licensee allows the customer to opt out by any
				reasonable means within thirty (30) days after the date that the customer
				acknowledges receipt of the notices in conjunction with opening the
				account.
3. For an isolated transaction,
				such as providing the consumer with an insurance quote, the licensee provides the
				notices required in subdivisions a and b of this subsection at the time of the
				transaction and requests that the consumer decide, as a necessary part of the
				transaction, whether to opt out before completing the transaction.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-10 - Limits on Redisclosure and Reuse of Nonpublic Personal Financial Information

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. If a licensee
				receives nonpublic personal financial information from a nonaffiliated financial
				institution under an exception in sections 13 or 14 of this rule, the licensee's
				disclosure and use of that information is limited as follows:
a. The licensee may disclose the information to
				the affiliates of the financial institution from which the licensee received the
				information;
b. The licensee may
				disclose the information to its affiliates, but the licensee's affiliates may, in
				turn, disclose and use the information only to the extent that the licensee may
				disclose and use the information; and
c. The licensee may disclose and use the
				information pursuant to an exception in sections 13 or 14 of this rule, in the
				ordinary course of business to carry out the activity covered by the exception under
				which the licensee received the information.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-11 - Limits on Sharing Account Number Information for Marketing Purposes

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. A licensee shall not, directly or through an
				affiliate, disclose, other than to a consumer reporting agency, a policy number or
				similar form of access number or access code for a consumer's policy or transaction
				account to any nonaffiliated third party for use in telemarketing, direct mail
				marketing or other marketing through electronic mail to the consumer.
11.2. Subsection 11.1 does not apply if a licensee
				discloses a policy number or similar form of access number or access code:
a. To the licensee's service provider solely in
				order to perform marketing for the licensee's own products or services, as long as
				the service provider is not authorized to directly initiate charges to the
				account;
b. To a licensee who is a
				producer solely in order to perform marketing for the licensee's own products or
				services; or
c. To a participant in an
				affinity or similar program where the participants in the program are identified to
				the customer when the customer enters into the program.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-12 - Exception to Opt-Out Requirements for Disclosure of Nonpublic Personal Financial Information for Service Providers and Joint Marketing

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. The opt-out requirements in sections 6 and 9
				do not apply when a licensee provides nonpublic personal financial information to a
				nonaffiliated third party to perform services for the licensee or functions on the
				licensee's behalf, if the licensee:
a. Provides
				the initial notice in accordance with section 3; and
b. Enters into a contractual agreement with the
				third party that prohibits the third party from disclosing or using the information
				other than to carry out the purposes for which the licensee disclosed the
				information, including use under an exception in sections 13 or 14 in the ordinary
				course of business to carry out those purposes.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-57 - Privacy Of Consumer Financial And Health Information › Section 114-57-13 - Exceptions to Notice and Opt-Out Requirements for Disclosure of Nonpublic Personal Financial Information for Processing and Servicing Transactions

Current through Register Vol. XLI, No. 28, July 12, 2024
13.1. The requirements
				for initial notice in subdivision b of subsection 3.1, opting out in sections 6 and
				9, and service providers and joint marketing in section 12 do not apply if the
				licensee discloses nonpublic personal financial information as necessary to effect,
				administer or enforce a transaction that a consumer requests or authorizes, or in
				connection with:
a. Servicing or processing an
				insurance product or service that a consumer requests or authorizes;
b. Maintaining or servicing the consumer's account
				with a licensee, or with another entity as part of a private label credit card
				program or other extension of credit on behalf of such entity;
c. A proposed or actual securitization, secondary
				market sale (including sales of servicing rights) or similar transaction related to
				a transaction of the consumer; or
d.
				Reinsurance or stop loss or excess loss insurance.