reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-10 - Medicare Select Policies and Certificates

Current through July 13, 2024
(a) This section shall apply to Medicare
				Select policies and certificates, as defined in this section. No policy or
				certificate may be advertised as a Medicare Select policy or certificate unless
				it meets the requirements of this section.
(b) For the purposes of this section:
(i) "Complaint" means any dissatisfaction
				expressed by an individual concerning a Medicare Select issuer or its network
				providers.
(ii) "Grievance" means
				dissatisfaction expressed in writing by an individual insured under a Medicare
				Select policy or certificate with the administration, claims practices, or
				provision of services concerning a Medicare Select issuer or its network
				providers.
(iii) "Medicare Select
				issuer" means an issuer offering, or seeking to offer, a Medicare Select policy
				or certificate.
(iv) "Medicare
				Select policy" or "Medicare Select certificate" mean respectively a Medicare
				supplement policy or certificate that contains restricted network
				provisions.
(v) "Network provider"
				means a provider of health care, or a group of providers of health care, which
				has entered into a written agreement with the issuer to provide benefits
				insured under a Medicare Select policy.
(vi) "Restricted network provision" means any
				provision which conditions the payment of benefits, in whole or in part, on the
				use of network providers.
(vii)
				"Service area" means the geographic area approved by the commissioner within
				which an issuer is authorized to offer a Medicare Select policy.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-11 - Open Enrollment

Current through July 13, 2024
(a) An issuer shall not deny or condition the
				issuance or effectiveness of any Medicare supplement policy or certificate
				available for sale in this state, nor discriminate in the pricing of a policy
				or certificate because of the health status, claims experience, receipt of
				health care, or medical condition of an applicant in the case of an application
				for a policy or certificate that is submitted prior to or during the six (6)
				month period beginning with the first day of the first month in which an
				individual is both 65 years of age or older and is enrolled for benefits under
				Medicare Part B. Each Medicare supplement policy and certificate currently
				available from an insurer shall be made available to all applicants who qualify
				under this subsection without regard to age.
(b) If an applicant:
(i) Qualifies under Subsection (a) and
				submits an application during the time period referenced in Subsection (a) and,
				as of the date of application, has had a continuous period of creditable
				coverage of at least six months, the issuer shall not exclude benefits based on
				a preexisting condition.
(ii)
				Qualifies under Subsection (a) and submits an application during the time
				period referenced in Subsection (a) and, as of the date of application, has had
				a continuous period of creditable coverage that is less than six months, the
				issuer shall reduce the period of any preexisting condition exclusion by the
				aggregate of the period of creditable coverage applicable to the applicant as
				of the enrollment date. The Secretary shall specify the manner of the reduction
				under this subsection.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-12 - Guaranteed Issue for Eligible Persons

Current through July 13, 2024
(a) Guaranteed Issue.
(i) Eligible persons are those individuals
				described in Subsection (b) who seek to enroll under the policy during the
				period specified in Subsection (c), and who submit evidence of the date of
				termination, disenrollment, or Medicare Part D enrollment with the application
				for a Medicare supplement policy.
(ii) With respect to eligible persons, an
				issuer shall not deny or condition the issuance or effectiveness of a Medicare
				supplement policy described in Subsection (e) that is offered and is available
				for issuance to new enrollees by the issuer, shall not discriminate in the
				pricing of such a Medicare supplement policy because of health status, claims
				experience, receipt of health care, or medical condition, and shall not impose
				an exclusion of benefits based on a preexisting condition under such a Medicare
				supplement policy.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-13 - Standards for Claims Payment

Current through July 13, 2024
(a) An issuer shall comply with section
				1882(c)(3) of the Social Security Act (as enacted by section 4081(b)(2)(C) of
				the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203
				) by:
(i) Accepting a notice from a Medicare
				carrier on dually assigned claims submitted by participating physicians and
				suppliers as a claim for benefits in place of any other claim form otherwise
				required and making a payment determination on the basis of the information
				contained in that notice;
(ii)
				Notifying the participating physician or supplier and the beneficiary of the
				payment determination;
(iii) Paying
				the participating physician or supplier directly;
(iv) Furnishing, at the time of enrollment,
				each enrollee with a card listing the policy name, number and a central mailing
				address to which notices from a Medicare carrier may be sent;
(v) Paying user fees for claim notices that
				are transmitted electronically or otherwise; and
(vi) Providing to the Secretary of Health and
				Human Services, at least annually, a central mailing address to which all
				claims may be sent by Medicare carriers.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-14 - Loss Ratio Standards and Refund or Credit of Premium

Current through July 13, 2024
(a) Loss Ratio Standards.
(i) Medicare Supplement Policy Form or
				Certificate Form.
(A) Shall not be delivered
				or issued for delivery unless the policy form or certificate form can be
				expected, as estimated for the entire period for which rates are computed to
				provide coverage, to return to policyholders and certificate holders in the
				form of aggregate benefits (not including anticipated refunds or credits)
				provided under the policy form or certificate form:
(I) At least seventy-five percent (75%) of
				the aggregate amount of premiums earned in the case of group policies;
				or
(II) At least sixty-five percent
				(65%) of the aggregate amount of premiums earned in the case of individual
				policies;
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-15 - Filing and Approval of Policies and Certificates and Premium Rates

Current through July 13, 2024
(a) An issuer shall not deliver or issue for
				delivery a policy or certificate to a resident of this state unless the policy
				form or certificate form has been filed with and approved by the commissioner
				in accordance with filing requirements and procedures prescribed by the
				commissioner.
(b) An issuer shall
				file any riders or amendments to policy or certificate forms to delete
				outpatient prescription drug benefits as required by the Medicare Prescription
				Drug, Improvement, and Modernization Act of 2003 only with the commissioner in
				the state in which the policy or certificate was issued.
(c) An issuer shall not use or change premium
				rates for a Medicare supplement policy or certificate unless the rates, rating
				schedule and supporting documentation have been filed with and approved by the
				commissioner in accordance with the filing requirements and procedures
				prescribed by the commissioner.
(d)
				Multiple Policy or Type.
(i) Except as
				provided in Paragraph (ii) of this subsection, an issuer shall not file for
				approval more than one form of a policy or certificate of each type for each
				standard Medicare supplement benefit plan.
(ii) An issuer may offer, with the approval
				of the commissioner, up to four (4) additional policy forms or certificate
				forms of the same type for the same standard Medicare supplement benefit plan,
				one for each of the following cases:
(A) The
				inclusion of new or innovative benefits;
(B) The addition of either direct response or
				agent marketing methods;
(C) The
				addition of either guaranteed issue or underwritten methods;
(D) The offering of coverage to individuals
				eligible for Medicare by reason of disability.
(iii) For the purposes of this section, a
				"type" means an individual policy, a group policy, an individual Medicare
				Select policy, or a group Medicare Select policy.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-16 - Permitted Compensation Arrangements

Current through July 13, 2024
(a) An issuer or other entity may provide
				commission or other compensation to an agent or other representative for the
				sale of a Medicare supplement policy or certificate only if the first year
				commission or other first year compensation is no more than 200 percent of the
				commission or other compensation paid for selling or servicing the policy or
				certificate in the second year or period.
(b) The commission or other compensation
				provided in subsequent (renewal) years must be the same as that provided in the
				second year or period and must be provided for no fewer than five (5) renewal
				years.
(c) No issuer or other
				entity shall provide compensation to its agents or other producers and no agent
				or producer shall receive compensation greater than the renewal compensation
				payable by the replacing issuer on renewal policies or certificates if an
				existing policy or certificate is replaced.
(d) For purposes of this section,
				"compensation" includes pecuniary or non- pecuniary remuneration of any kind
				relating to the sale or renewal of the policy or certificate including but not
				limited to bonuses, gifts, prizes, awards and finders fees.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-19 - Filing Requirements for Advertising

Current through July 13, 2024
An issuer shall provide a copy of any Medicare supplement
				  advertisement intended for use in this state whether through written, radio or
				  television medium to the Commissioner of Insurance of this state for review or
				  approval by the commissioner to the extent it may be required under state
				  law.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-20 - Standards for Marketing

Current through July 13, 2024
(a) An issuer, directly or through its
				producers, shall:
(i) Establish marketing
				procedures to assure that any comparison of policies by its agents or other
				producers will be fair and accurate.
(ii) Establish marketing procedures to assure
				excessive insurance is not sold or issued.
(iii) Display prominently by type, stamp or
				other appropriate means, on the first page of the policy the following:
"Notice to buyer: This policy may not cover all of
				  your medical expenses."
(iv) Inquire and otherwise make every
				reasonable effort to identify whether a prospective applicant or enrollee for
				Medicare supplement insurance already has accident and sickness insurance and
				the types and amounts of any such insurance.
(v) Establish auditable procedures for
				verifying compliance with this Subsection (a).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-21 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through July 13, 2024
(a) In recommending the purchase or
				replacement of any Medicare supplement policy or certificate an agent shall
				make reasonable efforts to determine the appropriateness of a recommended
				purchase or replacement.
(b) Any
				sale of a Medicare supplement policy or certificate that will provide an
				individual more than one Medicare supplement policy or certificate is
				prohibited.
(c) An issuer shall not
				issue a Medicare supplement policy or certificate to an individual enrolled in
				Medicare Part C unless the effective date of the coverage is after the
				termination date of the individual's Part C coverage.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-22 - Reporting of Multiple Policies

Current through July 13, 2024
(a) On or before March 1 of each year, an
				issuer shall report the following information for every individual resident of
				this state for which the issuer has in force more than one Medicare supplement
				policy or certificate:
(i) Policy and
				certificate number; and
(ii) Date
				of issuance.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-23 - Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates

Current through July 13, 2024
(a) If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate, the
				replacing issuer shall waive any time periods applicable to preexisting
				conditions, waiting periods, elimination periods and probationary periods in
				the new Medicare supplement policy or certificate for similar benefits to the
				extent such time was spent under the original policy.
(b) If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate which
				has been in effect for at least ninety (90) days, the replacing policy shall
				not provide any time period applicable to preexisting conditions, waiting
				periods, elimination periods and probationary periods for benefits similar to
				those contained in the original policy or certificate.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-24 - Prohibition Against Use of Genetic Information and Requests for Genetic TestingThis Section applies to all policies with policy years beginning on or after May 21, 2009

Current through July 13, 2024
(a) An issuer of a Medicare supplement policy
				or certificate:
(i) shall not deny or
				condition the issuance or effectiveness of the policy or certificate (including
				the imposition of any exclusion of benefits under the policy based on a
				preexisting condition) on the basis of the genetic information with respect to
				such individual; and
(ii) shall not
				discriminate in the pricing of the policy or certificate (including the
				adjustment of premium rates) of an individual on the basis of the genetic
				information with respect to such individual.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Appendix A - MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR

Current through July 13, 2024
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Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-1 - Purpose

Current through July 13, 2024
The purpose of this regulation is to implement Chapter 38 of
				  the Wyoming Insurance Code, to promote the public interest, to promote the
				  availability of long-term care insurance coverage, to protect applicants for
				  long-term care insurance, as defined, from unfair or deceptive sales or
				  enrollment practices, to facilitate public understanding and comparison of
				  long-term care insurance coverages, and to facilitate flexibility and
				  innovation in the development of long-term care insurance.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-2 - Authority

Current through July 13, 2024
This regulation is issued pursuant to the authority vested in
				  the Wyoming Insurance Commissioner under
				  W.S.
				  26-2-110 and W.S. W.S.
				  W.S.
				  26-38-101 through W.S. W.S.
				  W.S.
				  26-38-106 of the Wyoming Insurance Code and
				  W.S. W.S. W.S. 16-3-101, et seq., of the
				  Wyoming Administrative Procedure Act.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-3 - Applicability and Scope

Current through July 13, 2024
Except as otherwise specifically provided, this regulation
				  applies to all long-term care insurance policies delivered or issued for
				  delivery in this state on or after the effective date hereof, by insurers;
				  fraternal benefit societies; nonprofit health, hospital and medical service
				  corporations; prepaid health plans, health maintenance organizations and all
				  similar organizations.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-4 - Definitions

Current through July 13, 2024
For purposes of this regulation, the terms "long-term care
				  insurance," "group long-term care insurance," "commissioner," "applicant,"
				  "policy" and "certificate" shall have the meanings set forth in
				  W.S.
				  26-38-103 of the Wyoming Insurance
				  Code.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-6 - Policy Practices and Provisions

Current through July 13, 2024
(a) Renewability.
				The terms "guaranteed renewable" and "noncancellable" shall not be used in any
				individual long-term care insurance policy without further explanatory language
				in accordance with the disclosure requirements of Section 7 of this regulation.
(i) No such policy issue d to an individual
				shall contain renewal provisions less favorable to the insured than "guaranteed
				renewable." However, the Commissioner may authorize nonrenewal on a statewide
				basis, on terms and conditions deemed necessary by the Commissioner, to best
				protect the interests of the insureds, if the insurer demonstrates:
(A) That renewal will jeopardize the
				insurer's solvency: or
(B) That:
(I) The actual paid claims and expenses have
				substantially exceeded the premium and investment income associated with the
				policies; and
(II) The policies
				will continue to experience substantial and unexpected losses over their
				lifetime; and
(III) The projected
				loss experience of the policies cannot be significantly improved or mitigated
				through reasonable rate adjustments or other reasonable methods; and
(IV) The insurer has made repeated and good
				faith attempts to stabilize loss experience of the policies, including the
				timely filing for rate adjustments.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-8 - Prohibition Against Post-Claims Underwriting

Current through July 13, 2024
(a) All
				applications for long-term care insurance policies or certificates except those
				which are guaranteed issue shall contain clear and unambiguous questions
				designed to ascertain the health condition of the applicant.
(b)
(i) If
				an application for long-term care insurance contains a question which asks
				whether the applicant has had medication prescribed by a physician, it must
				also ask the applicant to list the medication that has been
				prescribed.
(ii) If the medications
				listed in such application were known by the insurer, or should have been known
				at the time of application, to be directly related to a medical condition for
				which coverage would otherwise be denied, then the policy or certificate shall
				not be rescinded for that condition.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-9 - Minimum Standards for Home Health Care Benefits in Long-Term Care Insurance Policies

Current through July 13, 2024
(a) A long-term
				care insurance policy or certificate may not, if it provides benefits for home
				health care services, limit or exclude benefits:
(i) By requiring that the insured/claimant
				would need skilled care in a skilled nursing facility if home health care
				services were not provided;
(ii) By
				requiring that the insured/claimant first or simultaneously receive nursing
				and/or therapeutic services in a home or community setting before home health
				care services are covered;
(iii) By
				limiting eligible services to services provided by registered nurses or
				licensed practical nurses;
(iv) By
				requiring that a nurse or therapist provide services covered by the policy that
				can be provided by a home health aide, or other licensed or certified home care
				worker acting within the scope of his or her licensure or
				certification.
(v) By requiring
				that the insured/claimant have an acute condition before home health care
				services are covered.
(vi) By
				limiting benefits to services provided by Medicare-certified agencies or
				providers.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-10 - Requirement to Offer Inflation Protection

Current through July 13, 2024
(a) No insurer may
				offer a long-term care insurance policy unless the insurer also offers to the
				policyholder the option to purchase a policy that provides for benefit levels
				to increase with benefit maximums or reasonable durations which are meaningful
				to account for reasonably anticipated increases in the costs of long-term care
				services covered by the policy. Insurers must offer to each policyholder, at
				the time of purchase, the option to purchase a policy with an inflation
				protection feature no less favorable than one of the following:
(i) Increases benefit levels annually [in a
				manner so that the increases are compounded annually];
(ii) Guarantees the insured individual the
				right to periodically increase benefit levels without providing evidence of
				insurability or health status so long as the option for the previous period has
				not been declined; or
(iii) Covers
				a specified percentage of actual or reasonable charges.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-12 - Discretionary Powers of Commissioner

Current through July 13, 2024
The Commissioner may, upon written request and after an
				  administrative hearing, issue an order to modify or suspend a specific
				  provision or provisions of this regulation with respect to a specific long-term
				  care insurance policy or certificate upon a written finding that:
(a) The modification or suspension would be
				in the best interest of the insureds; and
(b) The purposes to be achieved could not be
				effectively or efficiently achieved without the modification or suspension;
				and
(c)
(i) The modification or suspension is
				necessary to the development of an innovative and reasonable approach for
				insuring long-term care; or
(ii)
				The policy or certificate is to be issued to residents of a life care or
				continuing care retirement community or some other residential community for
				the elderly and the modification or suspension is reasonably related to the
				special needs or nature of such a community; or
(iii) The modification or suspension is
				necessary to permit long-term care insurance to be sold as part of, or in
				conjunction with, another insurance product.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-13 - Loss Ratio

Current through July 13, 2024
Benefits under individual long-term care insurance policies
				  shall be deemed reasonable in relation to premiums provided the expected loss
				  ratio is at least sixty percent, calculated in a manner which provides for
				  adequate reserving of the long-term care insurance risk. In evaluating the
				  expected loss ratio, due consideration shall be given to all relevant factors,
				  including:
(a) Statistical credibility
				of incurred claims experience and earned premiums;
(b) The period for which rates are computed
				to provide coverage;
(c)
				Experienced and projected trends;
(d) Concentration of experience within early
				policy duration;
(e) Expected claim
				fluctuation;
(f) Experience
				refunds, adjustments or dividends;
(g) Renewability features;
(h) All appropriate expense
				factors;
(i) Interest;
(j) Experimental nature of the
				coverage;
(k) Policy
				reserves;
(l) Mix of business by
				risk classification; and
(m)
				Product features such as long elimination periods, high deductibles and high
				maximum limits.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-14 - Filing Requirement

Current through July 13, 2024
Prior to an insurer or similar organization offering group
				  long-term care insurance to a resident of this state pursuant to
				  W.S.
				  26-38-104, it shall file with the
				  Commissioner evidence that the group policy or certificate thereunder has been
				  approved by a state having statutory or regulatory long-term care insurance
				  requirements substantially similar to those adopted in this
				  state.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-15 - Filing Requirements for Advertising

Current through July 13, 2024
(a) Every insurer,
				health care service plan or other entity providing long-term care insurance or
				benefits in this state, shall provide a copy of any long-term care insurance
				advertisement intended for use in this state, whether through written, radio,
				television or Internet medium to the Commissioner of Insurance for review and
				approval by the Commissioner. In addition, all advertisements shall be retained
				by the insurer, health care service plan or other entity for at least three (3)
				years from the date the advertisement was first used.
(b) The Commissioner may exempt from these
				requirements any advertising form or material when, in the Commissioner's
				opinion, this requirement may not be reasonably applied.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-16 - Nonforfeiture Benefit Requirement

Current through July 13, 2024
(a) This section
				does not apply to life insurance policies or riders containing accelerated
				long-term care benefits.
(b) To
				comply with the requirement to offer a nonforfeiture benefit pursuant to
				W.S.
				26-38-109:
(i) A policy or certificate offered with
				nonforfeiture benefits shall have coverage elements, eligibility, benefit
				triggers and benefit length that are the same as coverage to be issued without
				nonforfeiture benefits. The nonforfeiture benefit included in the offer shall
				be the benefit described in subsection (e); and
(ii) The offer shall be in writing if the
				nonforfeiture benefit is not otherwise described in the Outline of Coverage or
				other materials given to the prospective policyholder.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-17 - Standards for Benefit Triggers

Current through July 13, 2024
(a) A long-term
				care insurance policy shall condition the payment of benefits on a
				determination of the insured's ability to perform activities of daily living
				and on cognitive impairment. Eligibility for the payment of benefits shall not
				be more restrictive than requiring either a deficiency in the ability to
				perform not more than three (3) of the activities of daily living or the
				presence of cognitive impairment.
(b)
(i)
				Activities of daily living shall include at least the following as defined in
				Section 5 and in the policy:
(A)
				Bathing;
(B) Continence;
(C) Dressing;
(D) Eating;
(E) Toileting; and
(F) Transferring.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-18 - Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts

Current through July 13, 2024
(a) For purposes of
				this section the following definitions apply:
(i) "Qualified long-term care services" are
				as defined under
				W.S.
				26-38-103(a)(ix).
(ii)
(A)
				"Chronically ill individual" has the meaning prescribed for this term by
				Section 7702 B(c)(2) of the Internal Revenue Code of 1986, as amended. Under
				this provision, a chronically ill individual means any individual who has been
				certified by a licensed health care practitioner as:
(I) Being unable to perform (without
				substantial assistance from another individual) at least two (2) activities of
				daily living for a period of at least ninety (90) days due to a loss of
				functional capacity; or
(II)
				Requiring substantial supervision to protect the individual from threats to
				health and safety due to severe cognitive impairment.
(B) The term "chronically ill individual"
				shall not include an individual otherwise meeting these requirements unless
				within the preceding twelve-month period a licensed health care practitioner
				has certified that the individual meets these requirements.
(iii) "Licensed health care
				practitioner" means a physician, as defined in Section 1861(r)(1) of the Social
				Security Act, a registered professional nurse, licensed social worker or other
				individual who meets the requirements prescribed by the Secretary of the
				Treasury.
(iv) "Maintenance or
				personal care services" means any care the primary purpose of which is the
				provision of needed assistance with any of the disabilities as a result of
				which the individual is a chronically ill individual (including the protection
				from threats to health and safety due to severe cognitive
				impairment).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-20 - Requirement to Deliver Shopper's Guide

Current through July 13, 2024
(a) A long-term
				care insurance shopper's guide in the format developed by the National
				Association of Insurance Commissioners, or a guide developed or approved by the
				Commissioner, shall be provided to all prospective applicants of a long-term
				care insurance policy or certificate.
(i) In
				the case of agent solicitations, an agent must deliver the shopper's guide
				prior to the presentation of an application or enrollment form.
(ii) In the case of direct response
				solicitations, the shopper's guide must be presented in conjunction with any
				application or enrollment form.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-21 - Suitability

Current through July 13, 2024
(a) This section shall not apply to life
				insurance policies that accelerate benefits for long-term care.
(b) Every insurer, health care service plan
				or other entity marketing long-term care insurance shall:
(i) Develop and use suitability standards to
				determine whether the purchase or replacement of long-term care insurance is
				appropriate for the need of the applicant;
(ii) Train its agents in the use of its
				suitability standards; and
(iii)
				Maintain a copy of its suitability standards and make them available for
				inspection upon request by the Commissioner.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-22 - Separability

Current through July 13, 2024
If any provision of this regulation or the application
				  thereof to any person or circumstance is for any reason held to be invalid, the
				  remainder of the regulation and the application of such provision to other
				  persons or circumstances shall not be affected thereby.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Appendix A

Current through July 13, 2024
RECISSION REPORTING FORM FOR
LONG-TERM CARE POLICIES
FOR THE STATE OF WYOMING
FOR THE REPORTING YEAR 20[ ]
Company Name:________________________________________
Address:______________________________________________
_____________________________________________________
Phone Number:_________________________________________
Due: March 1 annually
Instructions:
The purpose of this form is to report all recissions of
				  long-term care insurance policies or certificates. Those rescissions
				  voluntarily effectuated by an insured are not required to be included in this
				  report. Please furnish one form per recission.
Date of Policy Date/s
Policy Policy and Name of Issuance Claim/s Date of
Form # Certificate # Insured Submitted Rescission
Detailed reason for
				  rescission:____________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________
Signature
_____________________
Name and Title (please type)
______________________
Date
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Appendix C - Things You Should Know Before Yo u Buy Long-Term Care Insurance

Current through July 13, 2024
Long-Term CareInsurance . A long-term care insurance policy
				  may pay most of the costs for your care in a nursing home. Many policies also
				  pay for care at home or other community settings. Since policies can vary in
				  coverage, you should read this policy and make sure you understand what it
				  covers before you buy it.
. [You should
not
buy this insurance policy
				  unless you can afford to pay the premiums every year.] [Remember that the
				  company can increase premiums in the future.]
Drafting Note
:For single premium policies,
				  delete this bullet; for noncancellable policies, delete the second sentence
				  only.
. The personal worksheet includes questions designed to help
				  you and the company determine whether this policy is suitable for your
				  needs.
Medicare . Medicare does
not
pay for most
				  long-term care.
Medicaid . Medicaid will generally pay for long-term care if
				  you have very little income and few assets. Yo u probably should
not
buy this policy if you are now eligible for Medicaid.
. Many people become eligible for Medicaid after they have
				  used up their own financial resources by paying for long-term care
				  services.
. When Medicaid pays your spouse's nursing home bills, you
				  are allowed to keep your house and furniture, a living allowance, and some of
				  your joint assets,
. Your choice of long-term care services may be limited if
				  you are receiving Medicaid. To learn more about Medicaid, contact your local or
				  state Medicaid agency.
Shopper's Guide . Make sure the insurance company or agent
				  gives you a copy of a book called the National Association of Insurance
				  Commissioners' "Shopper's Guide to Long-Term Care Insurance." Read it
				  carefully. If you have decided to apply for long-term care insurance, you have
				  the right to return the policy within 30 days and get back any premium you have
				  paid if you are dissatisfied for any reason or choose not to purchase the
				  policy.
Counseling . Free counseling and additional information about
				  long-term care insurance are available through your state's insurance
				  counseling program. Contact your state insurance department or department of
				  health, aging division for more info rmation about the senior health insurance
				  counseling program in your state.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Appendix D - Long-Term Care Insurance Suitability Letter

Current through July 13, 2024
Dear [Applicant]:
Your recent application for long-term care insurance included
				  a "personal worksheet," which asked questions about your finances and your
				  reasons for buying long-term care insurance. For your protection, state law
				  requires us to consider this information when we review your application, to
				  avoid selling a policy to those who may not need coverage.
[Your answers indicate that long-term care insurance may not
				  meet your financial needs. We suggest that you review the information provided
				  along with you application, including the booklet "Shoppers Guide to Long-Term
				  Care Insurance" and the page titled "Things Yo u Should Know Before Buying
				  Long-Term Care Insurance." Your state insurance department also has information
				  about long-term care insurance and may be able to refer you to a counselor free
				  of charge who can help you decide whether to buy this policy.]
[You chose not to provide any financial information for us to
				  review.]
Drafting Note
: Choose the paragraph that
				  applies.
We have suspended our final review of your application. If,
				  after careful consideration, you still believe this policy is what you want,
				  check the appropriate box below and return this letter to us within the next 60
				  days. We will then continue reviewing your application and issue a policy if
				  you meet our medical standards.
If we do not hear from you within the next 60 days, we will
				  close your file and not issue you a policy. You should understand that you will
				  not have any coverage until we hear back from you, approve your application and
				  issue a policy.
Please check one box and return in the enclosed
				  envelope.
G Yes
, [although my worksheet indicates that
				  long-term care insurance may not be a suitable purchase,] I wish to purchase
				  this coverage. Please resume review of my application.
Drafting Note
: Delete the phrase in brackets if
				  the applicant did not answer the questions about income.
G
No.
I have decided not to buy a
				  policy at this time.
_______________________ _______________________
APPLICANT'S SIGNATURE DATE
Please return to [issuer] at [address] by
				  [date].
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-1 - Authority

Current through July 13, 2024
These regulations are promulgated pursuant to W.S.
				  §§
									
										16-3-101
et seq
.,
				  
										26-2-110(a),
				  26-3-102(b) and
				  26-4-103.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-2 - Scope

Current through July 13, 2024
These regulations apply to each insurer that has direct
				  premium income from or as a result of persons, property, subjects or risks
				  located, resident, or to be performed in Wyoming.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-3 - Proper Proportionate Allocation of Premium Taxes

Current through July 13, 2024
(a) For the purpose of reporting and paying
				premium taxes, the amount of premium or consideration for insurance as to
				persons, property, subjects or risks in Wyoming insured, or covered under
				policies or contracts covering persons, property, subjects, or risks located or
				resident in more than one (1) state, shall be determined as follows:
(i) The result obtained when the percentage
				derived by dividing the number of Wyoming risks by the total number of risks
				under such policy or contract is multiplied by the total direct premium income
				derived from the policy or contract; or
(ii) The exact amount of premium or
				consideration collected from or on behalf of each person, property, subject or
				risk which is, in fact, located, resident or to be performed in
				Wyoming.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-4 - Exclusiveness

Current through July 13, 2024
No method of allocation which fails to recognize the actual
				  locations, residences, or situs of performance as used herein shall be
				  permissible.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-5 - Foreign Contracts

Current through July 13, 2024
These regulations are applicable notwithstanding the fact
				  that the policy or contract of insurance is entered into, or the premiums are
				  paid and received, in a state or states other than Wyoming.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-7 - Premium Tax Refunds

Current through July 13, 2024
Any claim for a refund due to an amended annual tax return
				  shall be filed with the subsequent annual tax return that is due on March 1 in
				  accordance with
				  W.S.
				  26-4-103(k)(ii).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-9 - Severability

Current through July 13, 2024
If any of the applications or provisions of these regulations
				  are held invalid, the invalidity shall not affect other applications or
				  provisions of this regulation which can be given effect without the invalid
				  applications or provisions, and to this end these regulations are
				  severable.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 38 - REGULATIONS GOVERNING ALLOCATION OF PREMIUM FOR THE PURPOSE OF TAXATION › Section 38-10 - Effective Date

Current through July 13, 2024
These regulations shall become effective for the tax-year
				  commencing 1 January 1983, which taxes are payable March
				  1,1984.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 39 - DISCLOSURE REQUIREMENTS FOR REPLACEMENT COST AND ACTUAL CASH VALUE POLICIES › Section 39-1 - Authority

Current through July 13, 2024
This regulation is promulgated pursuant to the authority
				  granted the Insurance Commissioner by
				  W.S.
				  26-2-110(a) and the Wyoming
				  Administrative Procedure Act.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 39 - DISCLOSURE REQUIREMENTS FOR REPLACEMENT COST AND ACTUAL CASH VALUE POLICIES › Section 39-2 - Purpose

Current through July 13, 2024
The purpose of this regulation is to prescribe standards for
				  the approval of policies and contracts of property insurance which are or may
				  become endorsed by an insurer to alter the method of valuation of an insured's
				  loss covered under such policies or contracts so as to ensure that such
				  endorsements do not contain misleading clauses, exceptions or conditions in
				  violation of
				  W.S.
				  26-15-113(a)
				  (ii).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 39 - DISCLOSURE REQUIREMENTS FOR REPLACEMENT COST AND ACTUAL CASH VALUE POLICIES › Section 39-3 - Applicability

Current through July 13, 2024
This regulation applies to all policies of insurance
				  delivered or issued for delivery in Wyoming or covering real or personal
				  property risks located in Wyoming or the renewal thereof as defined by
				  W.S.
				  26-5-104, but excluding policies covering
				  risks defined by W.S. W.S.
				  W.S.
				  26-5-106(a) (i) (ii) (iii) (ix) (x) (xi) (xii)
				  (xiv).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 39 - DISCLOSURE REQUIREMENTS FOR REPLACEMENT COST AND ACTUAL CASH VALUE POLICIES › Section 39-4 - Disclosure Required

Current through July 13, 2024
A policy of insurance shall contain on the declarations page,
				  in substance, a statement that the policy has been endorsed to provide
				  replacement cost coverage which supersedes actual cash value coverage if such
				  is the case.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 39 - DISCLOSURE REQUIREMENTS FOR REPLACEMENT COST AND ACTUAL CASH VALUE POLICIES › Section 39-5 - Segregation and Labeling Required

Current through July 13, 2024
The declarations page of any insurance policy so endorsed
				  under Section 4 herein and to which a co-insurance requirement applies shall
				  segregate and appropriately label any separately identified coverage to which
				  such endorsement applies according to the measure of damages applicable
				  thereto.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 39 - DISCLOSURE REQUIREMENTS FOR REPLACEMENT COST AND ACTUAL CASH VALUE POLICIES › Section 39-6 - Changes Within a Policy Period

Current through July 13, 2024
If any additional amendments or endorsements under Sections 4
				  or 5 herein are made to a policy during its term, a new declarations page shall
				  be issued.