reglab/statecodes huggingface dataset:
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 114-57-15 - When Authorization Required for Disclosure of Nonpublic Personal Health Information

Current through Register Vol. XLI, No. 28, July 12, 2024
15.1. A
				licensee shall not disclose nonpublic personal health information about a consumer
				or customer unless an authorization is obtained from the consumer or customer whose
				nonpublic personal health information is sought to be disclosed.
15.2. Nothing in this section shall prohibit,
				restrict or require an authorization for the disclosure of nonpublic personal health
				information by a licensee for the performance of the following insurance functions
				by or on behalf of the licensee: claims administration; claims adjustment and
				management; detection, investigation or reporting of actual or potential fraud,
				misrepresentation or criminal activity; underwriting; policy placement or issuance;
				loss control; ratemaking and guaranty fund functions; reinsurance and excess loss
				insurance; risk management; case management; disease management; quality assurance;
				quality improvement; performance evaluation; provider credentialing verification;
				utilization review; peer review activities; actuarial, scientific, medical or public
				policy research; grievance procedures; internal administration of compliance,
				managerial, and information systems; policyholder service functions; auditing;
				reporting; database security; administration of consumer disputes and inquiries;
				external accreditation standards; the replacement of a group benefit plan;
				activities in connection with a sale, merger, transfer or exchange of all or part of
				a business or operating unit; any activity that permits disclosure without
				authorization pursuant to the federal Health Insurance Portability and
				Accountability Act privacy rules promulgated by the U.S. Department of Health and
				Human Services; disclosure that is required, or is one of the lawful or appropriate
				methods, to enforce the licensee's rights or the rights of other persons engaged in
				carrying out a transaction or providing a product or service that a consumer
				requests or authorizes; and any activity otherwise permitted by law, required
				pursuant to governmental reporting authority, or to comply with legal process.
				Additional insurance functions may be added with the approval of the commissioner to
				the extent they are necessary for appropriate performance of insurance functions and
				are fair and reasonable to the interest of consumers.
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 114-57-16 - Authorizations

Current through Register Vol. XLI, No. 28, July 12, 2024
16.1. A valid
				authorization to disclose nonpublic personal health information pursuant to
				subsection 15.1 shall be in written or electronic form and shall contain all of the
				following:
a. The identity of the consumer or
				customer who is the subject of the nonpublic personal health information;
b. A general description of the types of nonpublic
				personal health information to be disclosed;
c. General descriptions of the parties to whom the
				licensee discloses nonpublic personal health information, the purpose of the
				disclosure and how the information will be used;
d. The signature of the consumer or customer who
				is the subject of the nonpublic personal health information or the individual who is
				legally empowered to grant authority and the date signed; and
e. Notice of the length of time for which the
				authorization is valid, which in no event shall be for more than twenty-four (24)
				months, and that the consumer or customer may revoke the authorization at any time
				and the procedure for making a revocation.
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 114-57-17 - Authorization Request Delivery

Current through Register Vol. XLI, No. 28, July 12, 2024
17.1. A
				request for authorization and an authorization form may be delivered to a consumer
				or a customer as part of an opt-out notice pursuant to section 8, provided that the
				request and the authorization form are clear and conspicuous. An authorization form
				is not required to be delivered to the consumer or customer or included in any other
				notices unless the licensee intends to disclose protected health information
				pursuant to subsection 15.1.
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 114-57-18 - Relationship to Federal Rules

Current through Register Vol. XLI, No. 28, July 12, 2024
18.1.
				Irrespective of whether a licensee is subject to the federal Health Insurance
				Portability and Accountability Act privacy rule as promulgated by the U.S.
				Department of Health and Human Services [65 Fed. Reg. 82461-82829 (Dec. 28, 2000)
				(to be codified at 45 C.F.R. Parts 160 through 164)] (the "federal rule"), if a
				licensee complies with all requirements of the federal rule except for its effective
				date provision, the licensee shall not be subject to the provisions of sections 15,
				16, and 17 of this rule.
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 114-57-19 - Relationship to State Laws

Current through Register Vol. XLI, No. 28, July 12, 2024
19.1. Nothing in
				sections 15, 16, and 17 shall preempt or supercede existing state law related to
				medical records, health or insurance information privacy.
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 114-57-20 - Protection of Fair Credit Reporting Act

Current through Register Vol. XLI, No. 28, July 12, 2024
20.1. Nothing in this rule shall be construed to
				modify, limit or supersede the operation of the federal Fair Credit Reporting Act (
				15 U.S.C.
				1681 et seq.), and no inference shall be drawn on
				the basis of the provisions of this rule regarding whether information is
				transaction or experience information under section 603 of that Act.
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 114-57-21 - Nondiscrimination

Current through Register Vol. XLI, No. 28, July 12, 2024
21.1. A licensee shall
				not unfairly discriminate against any consumer or customer because that consumer or
				customer has opted out from the disclosure of his or her nonpublic personal
				financial information pursuant to the provisions of this rule.
21.2. A licensee shall not unfairly discriminate
				against a consumer or customer because that consumer or customer has not granted
				authorization for the disclosure of his or her nonpublic personal health information
				pursuant to the provisions of this rule.
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 114-57-22 - Construction

Current through Register Vol. XLI, No. 28, July 12, 2024
22.1. Rule of
				Construction. -- The examples in this rule and the sample clauses in Appendix A of
				this rule are not exclusive. Compliance with an example or use of a sample clause,
				to the extent applicable, constitutes compliance with this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to provide standards for the external review process set
				forth in W. Va. Code '33-25C-6,
				including the procedures for selection of and assignment of external review
				organizations.
a. Except as otherwise provided,
				this rule applies to:
1. Health maintenance
				organizations and prepaid limited health service organizations; and
2. External review organizations seeking approval
				by the commissioner to conduct external reviews on behalf of managed care
				plans.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Adverse
				determination" means a determination by a managed care plan or its designated
				utilization review organization that an admission, availability of coverage,
				continued stay or other health care service that is a covered benefit has been
				reviewed and, based upon the information provided, does not meet the managed care
				plan's requirements for medical necessity, or is experimental.
2.2. "Authorized representative" means:
a. A person to whom the enrollee has given
				express, written consent to represent the enrollee in an external review;
b. A person authorized by law to provide
				substituted consent for an enrollee, including, but not limited to, a guardian or
				agent under a power of attorney; or
c.
				A family member of the enrollee or the enrollee's treating health care professional
				with the express written permission of the person, or, if incapacitated, a family
				member, if a situation exists which would warrant an expedited review pursuant to
				subsection 6.1 of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-3 - Notice of Right to External Review

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. At the
				time the managed care plan sends written notice to the enrollee of an adverse
				determination, the managed care plan shall, if the enrollee has exhausted the
				managed care plan's internal review process, also notify the enrollee in writing of
				the enrollee's right to request an external review and shall include in the required
				notice:
a. The specific criteria and standards on
				which the adverse determination was based. Use of generalized terms such as
				"experimental procedure not covered," or "not medically necessary" is not sufficient
				to comply with this requirement;
b. A
				description of both the standard and expedited external review procedures;
c. The circumstances under which the enrollee or
				the enrollee's authorized representative may use either procedure;
d. The procedures for requesting an external
				review, including the time within which an external review must be
				requested;
e. The procedures giving the
				enrollee or the enrollee's authorized representative the opportunity to submit
				additional information;
f. The
				disclosure that the enrollee will not be responsible for the cost of the external
				review; and
g. All forms necessary to
				process an external review, including a form by which the enrollee or the enrollee's
				authorized representative may authorize the plan to disclose pertinent protected
				health information concerning the enrollee to the external review
				organization.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-4 - Request for External Review

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. An
				enrollee or the enrollee's authorized representative may make a request for external
				review of an adverse determination only where the denial, reduction, modification or
				termination of payment for health care services or course of health care services
				would result in payment of at least one thousand dollars if the health care services
				were paid for by the enrollee. The enrollee must submit documentation from his or
				her provider verifying that the cost of the health care services would result in
				payment of at least one thousand dollars if paid for by the enrollee.
4.2. Except for a request for an expedited
				external review made pursuant to section 6, all requests for external review shall
				be made in writing to the commissioner and the managed care plan. A request for an
				expedited external review may be made by electronic means to the commissioner and
				the managed care plan, followed by written confirmation not later than three
				business days after the electronic request is made.
4.3. Requests for external review shall be made:
a. Within sixty calendar days after the managed
				care plan has exceeded the time periods for grievances provided in W. Va. Code
				'33-25A-12, without
				reaching a decision; or
b. Within sixty
				calendar days after receiving written notice of an adverse determination by the
				managed care plan.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-5 - Standard External Review

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Within seven
				calendar days after receiving the written request for external review from the
				enrollee, a preliminary determination shall be completed by the commissioner to
				determine:
a. If the enrollee has provided all the
				information and forms necessary to process the external review request including,
				but not limited to, an authorization permitting disclosure of protected health
				information;
b. If the enrollee has
				received an adverse determination as defined in section 2 this rule;
c. If the adverse determination by the managed
				care plan would result in payment of at least one thousand dollars for health care
				services or a course of health care services if paid for by the enrollee;
d. If the individual is or was an enrollee in the
				plan at the time the health care service was requested, or in the case of a
				retrospective review, was an enrollee in the plan at the time the health care
				service was provided;
e. If the enrollee
				has exhausted all of the managed care plan's available internal grievance
				procedures; and
f. If the health care
				service that is the subject of the adverse determination reasonably appears to be a
				covered benefit under the plan. If the commissioner determines that the resolution
				of a medical issue is required for this determination, and if the request otherwise
				meets the requirements of this subsection, the commissioner shall certify the
				request for external review and proceed with assignment of an external review
				organization.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-6 - Expedited External Reviews

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Except for
				retrospective adverse determinations, an enrollee or an enrollee's authorized
				representative may request an expedited external review of an adverse determination
				in circumstances where failure of the enrollee to immediately receive the health
				care service could result in placing the health of the enrollee or the health of the
				enrollee's unborn child in serious jeopardy, cause serious impairment to bodily
				functions, or serious dysfunction of any bodily organ or part. Requests for
				expedited external review shall be made to the commissioner and the managed care
				plan.
6.2. A request for an expedited
				external review must include a certification from the enrollee's health care
				provider that the enrollee's medical condition meets the criteria set forth in
				subsection 6.1. Such certification shall include a clinical explanation of how the
				enrollee's condition meets the criteria.
6.3. Within two business days of receiving a
				request for an expedited external review, the commissioner shall determine if the
				criteria set forth in subsection 5.1 have been met, and shall send notification to
				the enrollee and the managed care plan of the following:
a. If the criteria for the preliminary
				determination set forth in subsection 5.1 have not been met, that the request is
				denied; or
b. If the criteria for the
				preliminary determination set forth in subsection 5.1 have been met and the request
				is complete, that the request has been certified for expedited external review. If
				certified by the commissioner, the commissioner shall randomly select an external
				review organization that does not have a conflict of interest and include in the
				notice the name, address, and telephone number of the external review organization
				to which the expedited review has been assigned.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-7 - Binding Nature of External Review Decision

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1.
				An external review decision is binding on the managed care plan.
7.2. An external review decision is binding on the
				enrollee except to the extent the enrollee has other remedies available under
				federal or state law.
7.3. An enrollee
				or an enrollee's authorized representative may not file a subsequent request for
				external review involving the same adverse determination for which the enrollee has
				already received an external review decision pursuant to W. Va. Code '33-25C-6 and this
				rule.
7.4. The external review
				organization may not order the managed care plan to provide a benefit or to pay a
				claim for a benefit that is excluded from coverage by the plan.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-8 - Approval of External Review Organizations

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. The commissioner shall approve external
				review organizations eligible to be assigned to conduct external reviews pursuant to
				W. Va. Code '33-25C-6 and this rule. An
				approval is effective for two years, unless the commissioner determines before
				expiration of the approval that the external review organization is not satisfying
				the minimum qualifications established under section 9 of this rule. The
				commissioner shall maintain a randomly organized roster of approved external review
				organizations.
8.2. An external review
				organization seeking approval to conduct external reviews shall submit an
				application on a form prescribed by the commissioner. The application shall include
				any documentation or information specified by the commissioner as necessary to
				determine if the external review organization meets the minimum qualifications
				established under section 9 of this rule. The external review organization will file
				with the application a schedule of fees and charges for approval by the
				commissioner.
8.3. To ensure continued
				compliance with this rule, the commissioner may:
a. Conduct periodic examinations and random audits
				of approved external review organizations. These examinations shall be at the
				expense of the external review organization.
b. Withdraw approval of the external review
				organization if the commissioner determines that an external review organization no
				longer satisfies the minimum requirements established under section 9 of this
				rule.
c. Investigate complaints by
				enrollees, managed care plans, and external reviewers regarding external
				reviews.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-9 - Minimum Qualifications for External Review Organizations

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. To be approved to conduct external reviews,
				an external review organization shall have and maintain written policies and
				procedures that govern all aspects of both the standard and expedited external
				review processes, which include, at a minimum:
a.
				A quality assurance program that:
1. Ensures that
				external reviews are conducted and all required notices are provided within the time
				frames specified in sections 5 and 6 of this rule;
2. Ensures the selection of qualified and
				impartial clinical peer reviewers to conduct external reviews on behalf of the
				external review organization and appropriate matching of clinical peers to specific
				cases;
3. Ensures the confidentiality of
				medical and treatment records, clinical review criteria, and personal information;
				and
4. Ensures that any person employed
				by or under the external review organization adheres to the requirements of this
				rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-10 - External Review Organization Reporting Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. An external review organization shall
				maintain records in the aggregate and by managed care plan on all standard and
				expedited external reviews it conducts pursuant to assignment by the commissioner
				during each calendar year. The external review organization shall retain the records
				required by this subsection for at least three years.
10.2. Each external review organization conducting
				an external review pursuant to assignment by the commissioner shall, by the 31st day
				of March of each year for the preceding calendar year, submit a report on a form
				prescribed by the commissioner. The report required by this subsection shall include
				in the aggregate, for each managed care plan, and for West Virginia external reviews
				only, the following information:
a. The total
				number of requests for external review;
b. The number of requests for external review
				resolved and, of those resolved, the number resolved upholding the adverse
				determination and the number resolved reversing the adverse determination;
c. The average length of time for standard
				external reviews and for expedited external reviews;
d. A summary of the types of coverages or cases
				for which an external reviews were sought and the types of health care plans
				involved in the external reviews;
e. The
				number of external reviews that were terminated at the request of the managed care
				plan as the result of a reconsideration by the managed care plan, except those
				external reviews terminated because the enrollee and/or the treating provider
				presented as part of the external review information that had not been provided to
				the plan prior to the external review; and
f. Any other information the commissioner may
				request or require.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-11 - Liability of External Review Organizations

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. Neither the external review organization nor
				any person who participates in an external review by investigating, reviewing
				materials, providing technical expertise or rendering a decision shall be civilly
				liable for any action that is taken in good faith, that is within the scope of the
				organization's or person's duties, and that doe not constitute wilful or reckless
				misconduct.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-12 - Exemption from External Review Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Upon written application to and approval by
				the commissioner a managed care plan may be exempted from the requirements for
				external review as specified in W. Va. Code '33-25C-6 upon a showing
				that:
a. The managed care plan has an established
				external review procedure in place;
b.
				The managed care plan has been reviewed by and maintains a current full
				accreditation from a nationally recognized accreditation and review organization
				approved by the commissioner, in accordance with W. Va. Code '33-25A-17a; and
c. As part of the accreditation
				process, the accreditation and review organization reviewed and approved the managed
				care plan's external review process.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-58 - External Review Of Coverage Denials › Section 114-58-13 - Electronic and Facsimile Transmissions

Current through Register Vol. XLI, No. 28, July 12, 2024
13.1.
				Any requirement set forth in this rule which requires an action by any party to be
				in writing shall be satisfied by electronic or facsimile transmission.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-59 - Consent To Rate And Guide "a" Rate Agreements › Section 114-59-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- Except as
				otherwise provided, this rule applies to any insurer authorized to transact
				insurance in West Virginia that writes policies providing medical malpractice
				insurance coverage for health care providers.
1.2. Authority. -- This rule is promulgated
				pursuant to the authority granted by W. Va. Code §§
									33-20B-2 and
				33-2-10.
1.3. Filing Date. -- April 3, 2003.
1.4. Effective Date. -- April 3, 2003.
1.5. Purpose. -- The purpose of this rule is to
				prescribe standards and procedures for reviewing and approving consent to rate
				agreements or guide "a" rates for medical malpractice insurance policies.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-59 - Consent To Rate And Guide "a" Rate Agreements › Section 114-59-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Commissioner"
				means the commissioner of insurance.
2.2. "Consent to rate" means a written agreement
				between an insurer and an insured resulting in a rate applied to the risk that
				exceeds the standard manual rate approved by the commissioner in a rate filing that
				would otherwise apply to the risk
2.3.
				"Guide 'a' rate" means a rate that is not backed up by credible loss experience
				statistics of the carrier writing the risk. These rates are used for unusual risks
				and are based on the judgment of an underwriter on an individual risk
				basis.
2.4. "Medical malpractice
				insurance" means insurance coverage for any claim for damages or loss against a
				health care provider arising out of the death or injury of any person proximately
				caused by negligence in the rendering of, or the failure to render, health care
				services.
2.5. "Non-standard rate" means
				a rate that is either higher or lower than manual rates set forth in an approved
				filing that would otherwise apply to a particular risk.
2.6. "Rating manual" means the rates, schedules of
				rates, classification rules, rating rules, minimum premiums, minimum premium rules,
				policy fees or rules and any other information which the insurer uses to determine
				the final dollar charge for medical professional liability insurance
				coverage.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-59 - Consent To Rate And Guide "a" Rate Agreements › Section 114-59-3 - Approval Required for All Non-standard Rates

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Any insurer that wishes to negotiate consent
				to rate agreements or apply guide "a" rates in connection with the issuance or
				renewal of any policy providing coverage for medical malpractice liability, shall
				first file with the commissioner as part of its filing made pursuant to subsection
				33-20B-3(a) of the West Virginia Code, or as a supplement to the filing, an appendix
				which describes the specific risks or reasons for which non-standard rates will be
				applied to particular risks. The appendix must also set forth the ranges of rates
				that will be applied to risks that may be the subject of consent to rate agreements:
Provided,
that the appendix is not required to include rate ranges
				that will apply to guide "a" rates.
3.2.
				An insurer shall obtain from the insurance applicant all information necessary to
				determine the proper application of a non-standard rate before seeking approval from
				the commissioner of a consent to rate agreement or guide "a" rate. The application
				for approval of a consent to rate agreement or the use of a guide "a" rate in
				connection with a specific risk shall be signed by the insured and the insurer, and
				shall be submitted by the insurer on the West Virginia Medical Malpractice Policy
				Agreement form, Appendix A to this rule. The original and one copy of the
				application shall be filed and shall be accompanied by a filing fee of $25.00 and a
				self-addressed postage prepaid envelope. Resubmission of a disapproved filing will
				require an additional filing fee. The filing fee shall be paid by the insurer and
				may not be passed on to the insured.
3.3. An application submitted by an insurer
				pursuant to subsection 3.2 of this rule shall:
a.
				In the case of a consent to rate agreement, include the insurer's certification that
				the risk or reasons for which approval of the consent to rate agreement is
				requested, and the rate to be applied to the risk, are set forth in the appendix to
				the rating manual previously approved by the commissioner as provided in subsection
				3.1 of this section; or
b. In the case
				of a guide "a" rate, demonstrate that the insurance applicant is a risk for which
				the insurer has no credible loss experience statistics.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-59 - Consent To Rate And Guide "a" Rate Agreements › Section 114-59-4 - Amendments to West Virginia Medical Malpractice Policy Agreement Form

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The commissioner may as needed amend the West
				Virginia Medical Malpractice Policy Agreement form, which is Appendix A to this
				rule, by procedural rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-59 - Consent To Rate And Guide "a" Rate Agreements › Section 114-59-5 - Violation

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Upon a
				determination by the commissioner that there is probable cause to believe that any
				insurer has charged a non-standard rate in violation of § 33-20B-2 of the West
				Virginia Code or this rule, the commissioner shall provide written notice to the
				insurer of the time and place at which the insurer shall appear to show good cause
				why a civil penalty, refund to the insured, or transfer from surplus should not be
				ordered.
5.2. If, after notice and
				hearing as provided in subsection 5.1 of this section, the commissioner determines
				that a violation has occurred, the commissioner shall assess a civil penalty and/or
				order that the insurer issue a refund to the insured or transfer from surplus the
				difference between the manual rate otherwise applicable to the risk and the rate
				charged.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-60 - Affidavits Of Custodian Banks › Section 114-60-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				procedural rule prescribes the form for affidavits of custodian banks for use in the
				following situations:
a. Where securities entrusted
				to its care have not been redeposited elsewhere;
b. Where a custodian bank maintains securities on
				deposit with the depository trust company or like entity; and
c. Where ownership of the securities is evidenced
				by book entry at a federal reserve bank.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-60 - Affidavits Of Custodian Banks › Section 114-60-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Custodian" means a
				national bank, state bank or trust company that shall at all times during which it
				acts as a custodian pursuant to this regulation be no less than adequately
				capitalized as determined by the standards adopted by United States banking
				regulators and that is regulated by either state banking laws or is a member of the
				federal reserve system and that is legally qualified to accept custody of securities
				in accordance with the standards set forth below, except that with respect to
				securities issued by institutions organized or existing under the laws of a foreign
				country, or securities used to meet the deposit requirements pursuant to the laws of
				a foreign country as a condition of doing business therein, "custodian" may include
				a bank or trust company incorporated or organized under the laws of a country other
				than the United States that is regulated as such by that country's government or an
				agency thereof that shall at all times during which it acts as a custodian pursuant
				to this regulation be no less than adequately capitalized as determined by the
				standards adopted by international banking authorities and that is legally qualified
				to accept custody of securities.
2.2.
				"Federal reserve book-entry procedure" means the computerized systems sponsored by
				the United States department of the treasury and certain agencies and
				instrumentalities of the United States for holding and transferring securities of
				the United States government and such agencies and instrumentalities, respectively,
				in federal reserve banks, through banks which are members of the federal reserve
				system or which otherwise have access to such computerized systems.
2.3. "Securities" means certificated securities as
				defined in W. Va. Code § 46-8-102a(4) and uncertificated securities as defined
				in subdivision (18) of that subsection.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-60 - Affidavits Of Custodian Banks › Section 114-60-3 - Custodian Affidavit Forms

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The
				affidavit forms attached to this rule, and made a part hereof as exhibit a, exhibit
				b and exhibit c, shall be used by a custodian when a written request has been made
				by an appropriate officer of the insurance company for an affidavit of the custodian
				in connection with a custody agreement.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-60 - Affidavits Of Custodian Banks › Appendix C

Current through Register Vol. XLI, No. 28, July 12, 2024
Clearing Corporation Use
[This form affidavit is for use where ownership is evidenced
				  by book entry at a Federal Reserve Bank.]
STATE OF ____________________________________)
)SS:_____________________
COUNTY OF __________________________________)
______________________________________________, being duly sworn
				  deposes and says that he or she
				  is__________________________of___________________________________, a banking
				  corporation organized under and pursuant to the laws of the _____________________,
				  with the principal place of business at
				  _______________________________________________
______________________________________________________________________________
				  (hereinafter called "the bank"):
That his or her duties involve supervision of activities of the
				  bank as custodian and records relating thereto;
That the bank is custodian for certain securities of
				  _____________________________________, with a place of business at
				  ________________________________________________________
_____________________________________________________________________________,
				  (hereinafter called "the insurance company") pursuant to an agreement between the
				  bank and the insurance company;
That it has caused certain securities to be credited to its bond
				  entry account with the Federal Reserve Bank of
				  ______________________________________________ under the Federal Reserve book-entry
				  procedure; and that the schedule attached hereto is a true and complete statement of
				  the securities of the insurance company of which the bank was custodian as of the
				  close of business on ________________________________, which were in a "General"
				  book-entry account maintained in the name of the bank on the books and records of
				  the Federal Reserve Bank of _____________________________________________ at such
				  date;
That the bank has the responsibility for the safekeeping of such
				  securities both in the possession of the bank or in said "General" book-entry
				  account as is specifically set forth in the agreement between the bank as custodian
				  and the insurance company; and
That, to the best of his or her knowledge and belief, unless
				  otherwise shown on the schedule, said securities were the property of said insurance
				  company and were free of all liens, claims or encumbrances whatsoever.
The foregoing instrument was acknowledged before me this ______
				  day of __________________, 20____, by
				  _________________________________________________
(Name of officer or agent, title of officer or agent)
of
				  ________________________________________________________,
(Name of corporation acknowledging)
a _____________________________ corporation, on behalf of the
				  corporation.
(state or place of incorporation)
Notary:___________________________________
My commission expires_____________________
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. --
1.1.a. The purposes of this rule are to promote
				the public welfare by regulating personal property insurance; create a legal
				framework within which credit personal property insurance may be written in this
				state; and help maintain the separation between creditors and insurers. It will also
				minimize the possibilities of unfair competitive practices in the sale of credit
				personal property insurance, and address problems that could arise from reverse
				competition in credit insurance markets. This rule is based on the National
				Association of Insurance Commissioners' "Credit Personal Property Insurance Model
				Act" (Model 365), as amended in 2003.
1.1.b. This rule applies to an insurer or producer
				transacting credit personal property insurance as defined in this rule and all
				credit personal property insurance written in connection with credit transactions
				for personal, family or household purposes. This rule does not include the
				following:
1.1.b.1. Transactions involving
				extensions of credit primarily for business or commercial purposes;
1.1.b.2. Insurance on motor vehicles designed for
				highway use and mobile homes;
1.1.b.3.
				Insurance written in connection with a credit transaction that is secured by a real
				estate mortgage or deed of trust;
1.1.b.4. Creditor-placed insurance;
1.1.b.5. Title insurance;
1.1.b.6. Non-filing insurance;
1.1.b.7. Insurance purchased by a creditor after
				repossession or a similar event where the creditor gains possession of the property;
				and
1.1.b.8. Insurance for which no
				identifiable charge is made to or collected from the debtor.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Closed-end credit"
				means a credit transaction that does not meet the definition of open-end
				credit.
2.2. "Collateral" means personal
				property in which a purchase money security interest is retained, or that is pledged
				as security for the satisfaction of a debt.
2.3. "Commissioner" means the West Virginia
				Insurance Commissioner.
2.4.
				"Compensation" means commissions, dividends, retrospective rate credits, service
				fees, expense allowances or reimbursements, gifts, furnishing of equipment,
				facilities, goods and services or any other form of remuneration that is paid either
				directly or indirectly as a result of the sale of credit property
				insurance.
2.5. "Credit agreement" means
				the written document that sets forth the terms of the credit transaction and
				includes the security agreement.
2.6.
				"Credit personal property insurance" means a policy, endorsement, rider, binder,
				certificate or other instrument or evidence of insurance written in connection with
				a credit transaction that:
2.6.a. Covers perils to
				the goods purchased through a credit transaction or used as collateral for a credit
				transaction and that concerns a creditor's interest in the purchased goods or
				pledged collateral either in whole or in part; or
2.6.b. Covers perils to goods purchased in
				connection with an open-end credit transaction.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-3 - Amount, Term and Coverage of Credit Personal Property Insurance; Prohibited Practices

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. For credit personal
				property insurance sold in conjunction with a closed-end transaction, an insurer may
				not issue credit personal property insurance coverage unless the amount financed
				exceeds five hundred dollars.
3.2. For
				credit personal property insurance sold in conjunction with a closed-end
				transaction, an insurer may not issue credit personal property insurance in an
				amount that exceeds the replacement value of the collateral, up to the amount
				financed in the underlying credit transaction, or with a term that exceeds in
				duration the scheduled term of the underlying credit transaction:
Provided
, That the debtor may obtain from the insurer, at his or
				her option, greater coverages for longer periods of time if he or she so desires, as
				authorized by W. Va. Code §
									46A-3-109(b)(1).
3.3. Credit personal property insurance coverage
				shall, at a minimum, include the coverages in the standard fire policy with coverage
				attachment, extended coverage endorsement, and replacement cost provision
				endorsement.
3.4. Credit personal
				property insurance shall cover a substantial risk of loss of or damage to the
				property related to the credit transaction.
3.5. An insurer may not require the bundling of
				other credit insurance coverages with the purchase of credit personal property
				insurance coverage. A debtor shall have the choice to purchase credit personal
				property insurance separate from other credit insurance coverage.
3.6. An insurer shall not use gross debt as an
				exposure base in determining credit personal property insurance premiums.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-4 - Disclosure to Debtors; Provisions of Policies; and Certificates of Insurance

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The following shall
				be disclosed to the debtor in writing, and may be combined with other disclosures
				required by W. Va. Code §
									46A-3-109(b)(4),
				or by federal laws and regulations:
4.1.a. That
				the purchase of credit personal property insurance through the creditor is optional
				and not a condition of obtaining credit approval;
4.1.b. If more than one kind of credit insurance
				is being made available to the debtor, that the debtor can purchase credit personal
				property insurance separately;
4.1.c.
				That if the consumer has other insurance that covers the risk, he or she may not
				want or need credit personal property insurance;
4.1.d. That within the first thirty days after
				receiving the individual policy or certificate of insurance, the debtor may cancel
				the coverage and have all premium paid by the debtor refunded or credited.
				Thereafter, the debtor may cancel the policy at any time during the term of the loan
				and receive a refund of any unearned premium. However, only in those instances where
				the creditor requires evidence of insurance for the extension of credit, the debtor
				may be required to offer evidence of alternative insurance acceptable to the
				creditor at the time of cancellation;
4.1.e. If not already contained in the certificate
				or policy received contemporaneously with the credit transaction, a brief
				description of the coverage, including a description of the major perils and
				exclusions, any deductible, to whom the benefits would be paid, and the premium or
				premium rate for the credit personal property coverage; and
4.1.f. If the premium or insurance charge is
				financed, that it will be subject to finance charges at the rate applicable to the
				credit transaction.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-5 - Filing and Approval of Rates and Forms

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. All policies, certificates of insurance,
				group and individual applications for insurance and enrollment forms, endorsements
				and riders delivered or issued for delivery in this state and the schedules of
				premium rates pertaining thereto shall be filed with the Commissioner and approved
				according to the provisions of W. Va. Code §§
									33-6-8,
				33-6-9
				and
				33-20-1,
				et seq.