reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-41A - Property And Casualty Actuarial Opinion › Section 114-41A-2 - Actuarial Opinion of Reserves and Supporting Documentation

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. This section shall become operative with
				respect to reporting years ending on or after December 31, 2011.
2.2. Statement of Actuarial Opinion. Every
				property and casualty insurance company doing business in this state, unless
				otherwise exempted by the Insurance Commissioner of this state or the commissioner
				in the state where the company is domiciled, shall annually submit the opinion of an
				Appointed Actuary entitled "Statement of Actuarial Opinion." This opinion shall be
				filed in accordance with the appropriate NAIC Property and Casualty Annual Statement
				Instructions.
2.3. Actuarial Opinion
				Summary.
2.3.a. Every property and casualty
				insurance company domiciled in this state that is required to submit a Statement of
				Actuarial Opinion shall annually submit an Actuarial Opinion Summary, written by the
				company's Appointed Actuary. This Actuarial Opinion Summary shall be filed in
				accordance with the appropriate NAIC Property and Casualty Annual Statement
				Instructions and shall be considered as a document supporting the Actuarial Opinion
				required in subsection 2.2 of this rule.
2.3.b. A company licensed but not domiciled in
				this state shall provide the Actuarial Opinion Summary upon request.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-41A - Property And Casualty Actuarial Opinion › Section 114-41A-3 - Confidentiality

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The Statement of
				Actuarial Opinion shall be provided with the Annual Statement in accordance with the
				appropriate NAIC Property and Casualty Annual Statement Instructions and shall be
				treated as a public document.
3.2. In
				order to assist in the performance of the Commissioner's duties, he or she may:
3.2.a. Share documents, materials or other
				information, including confidential and privileged documents, materials or
				information, with the Actuarial Board for Counseling and Discipline (ABCD) so long
				as the material is required for the purpose of professional disciplinary
				proceedings, with other states, federal and international regulatory agencies, with
				the NAIC and its affiliates and subsidiaries, and with state, federal and
				international law enforcement authorities, provided that the recipient agrees to
				maintain the confidentiality and privileged status of the document, material or
				other information and has the legal authority to maintain confidentiality;
3.2.b. Receive documents, materials or
				information, including otherwise confidential and privileged documents, materials or
				information, from the NAIC and its affiliates and subsidiaries, and from regulatory
				and law enforcement officials of other foreign or domestic jurisdictions, and shall
				maintain as confidential or privileged any document, material or information
				received with notice or the understanding that it is confidential or privileged
				under the laws of the jurisdiction that is the source of the document, material or
				information; and
3.2.c. Enter into
				agreements governing sharing and use of information consistent with subsection 3.2
				of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule establishes standards for continuing insurance education
				requirements and the sanctions to be imposed for failure to comply with such
				requirements.
1.2. Authority. -- W. Va.
				Code §§
									33-2-10,
				33-12-35 and
				33-12B-12.
1.3. Filing Date. -- June 6, 2022.
1.4. Effective Date. -- July 1, 2022.
1.5. Sunset Date. -- This rule shall terminate and
				have no further force or effect upon August 1, 2027.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
In addition to the definitions in W. Va. Code §§
									33-12-8
				  and
				  33-12B-1, the following
				  definitions apply:
2.1. "Approved course"
				means a course or program of instruction approved by the Commissioner and the Board
				of Insurance Agent Education for continuing insurance education credit.
2.2. "Biennium" means the two-year reporting
				period that is coextensive with the producer's license or adjuster's license
				period.
2.3. "Board" means the Board of
				Insurance Agent Education established pursuant to W. Va. Code §
									33-12-7
				and referred to in W. Va. Code §
									33-12B-13.
2.4. "Cancelled license" means a producer or
				adjuster license which has been:
2.4.1. Voluntarily
				voided by request of the individual insurance producer or individual insurance
				adjuster and approved by the Commissioner; or
2.4.2. Terminated for failure to satisfy the
				mandatory continuing education requirements as of the last day of the reporting
				period following his or her suspension.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-3 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. This rule applies
				to resident, individual insurance producers who are licensed by the Commissioner to
				engage in the sale of one or more of the following types of insurance:
3.1.1. Life insurance, annuity contracts, variable
				annuity contracts and variable life insurance;
3.1.2. Sickness, accident and health
				insurance;
3.1.3. All lines of property
				and casualty insurance;
3.1.4. Preneed
				burial insurance contracts;
3.1.5. All
				other lines of insurance for which an examination is required by the
				Commissioner;
3.1.6. Individual
				insurance producers appointed on behalf of a licensed health maintenance
				organization; and
3.1.7. Individual
				insurance producers engaged in telemarketing insurance products.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-4 - Exemptions

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Continuing
				education requirements for individual insurance producers shall not apply to:
4.1.1. Persons holding resident licenses for any
				kind or kinds of insurance for which an examination is not required by the
				Commissioner;
4.1.2. Persons selling
				only limited lines credit insurance and limited lines insurance;
4.1.3. Any such limited or restricted license as
				the Commissioner may exempt;
4.1.4.
				Individual insurance producers whose licenses have expired pursuant to W. Va. Code
				§
										33-12-17;
4.1.5. Individual insurance producers who have
				voluntarily cancelled their licenses; and
4.1.6. Non-resident individual insurance
				producers.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-5 - Continuing Insurance Education Course Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. A continuing insurance education course shall
				not qualify for use as continuing insurance education credit unless it is filed with
				and approved by the Commissioner and the Board.
5.2. A provider shall not implement any material
				change in a continuing insurance education course previously approved by the
				Commissioner until the change has been filed with and approved by the Commissioner
				and the Board.
5.3. The Commissioner
				will not give an individual insurance producer or individual insurance adjuster
				credit for any continuing insurance education course which is taken prior to the
				issuance of written approval by the Commissioner and the Board.
5.4. If a continuing insurance education course is
				taken more than once in a reporting period, the Commissioner will give the
				individual insurance producer or individual insurance adjuster credit only for the
				first time that the course was taken and completed during the applicable reporting
				period.
5.5. The Commissioner may
				withdraw approval of a continuing insurance education course for any of the
				following reasons:
5.5.1. The continuing insurance
				education course teaching methods or course content have been materially changed
				without being filed with or approved by the Commissioner and the Board;
5.5.2. The continuing insurance education course
				provider has certified to the Commissioner that an individual insurance producer or
				individual insurance adjuster has satisfactorily completed the course when the
				individual insurance producer or individual insurance adjuster has not done
				so;
5.5.3. The continuing insurance
				education course provider fails to certify to the Commissioner that the individual
				insurance producer or individual insurance adjuster has satisfactorily completed the
				course when, in fact, the individual insurance producer or individual insurance
				adjuster has done so; or
5.5.4. There is
				other good reason to withdraw approval of a continuing insurance education
				course.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-6 - Insurance Producer and Insurance Adjuster Continuing Insurance Education Exceptions; Extensions of Time; Cancelled License Procedures; and Reciprocity

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The Commissioner
				shall refuse to renew the appointments or issue new appointments for those lines of
				insurance specified in section 3 of this rule to any individual insurance producer
				who does not satisfy the minimum continuing insurance education
				requirements.
6.2. An individual
				insurance producer or individual insurance adjuster who is required to complete more
				than six hours of continuing education biennially and who exceed the minimum
				continuing education requirement for the biennial reporting period may carryover a
				maximum of six (6) credit hours into the next reporting period when the producer or
				adjuster has exceeded the minimum continuing education requirements for the current
				biennial reporting period.
6.3. Any
				individual insurance producer or individual insurance adjuster who has not complied
				with the continuing insurance education requirements by the end of the reporting
				period may thereafter obtain credit hours to be carried back to meet the
				requirements of the preceding reporting period. The Commissioner will assess a late
				submission fee of five dollars ($5.00) for each continuing insurance education
				credit hour obtained and submitted after the reporting period which are to be
				carried back to satisfy the requirements of the preceding reporting
				period.
6.4. A continuing insurance
				education course shall not qualify for use as continuing insurance education credit
				unless it is filed with and approved by the Commissioner and the Board.
6.5. An individual insurance producer or
				individual insurance adjuster who has an active annual membership in an organization
				or association recognized and approved by the Commissioner as a state, regional or
				national professional insurance organization or association may be approved by the
				Commissioner for up to two (2) credit hours of continuing insurance education in
				each biennial reporting period.
6.5.1. In
				determining whether to approve an organization's application for approval under this
				subsection, the Commissioner should consider:
6.5.1.a. The purpose and goals of the
				organization;
6.5.1.b. The extent to
				which the organization makes educational opportunities available to its
				members;
6.5.1.c. The degree to which
				the members participate in educational programs;
6.5.1.d. The extent to which the organization's
				educational programs and materials advance the knowledge of insurance-related
				topics; and
6.5.1.e. Any other criteria
				that the Commissioner deems advisable.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-7 - Proof of Completion

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Upon completion
				of a continuing insurance education course, the provider shall certify to the
				Commissioner the names of all individual insurance producers or individual insurance
				adjusters who satisfactorily completed the continuing insurance education course.
				The certification shall be in the form prescribed by the Commissioner.
7.1.1. The continuing education attendance
				certification roster shall be mailed by the provider to the Commissioner within
				thirty (30) days after the continuing insurance education course is completed. The
				provider shall submit a self-study course certification roster to the Commissioner
				within thirty (30) days of receipt of the completed course from the individual
				insurance producer or individual insurance adjuster.
7.1.2. The provider of the continuing insurance
				education course or a self-study continuing education course shall furnish a
				certificate of satisfactory completion to the individual insurance producer or
				individual insurance adjuster completing the course. The individual insurance
				producer or individual insurance adjuster shall retain a copy of the certificate for
				not less than four (4) years from the date the course is completed.
7.1.3. The provider shall retain a copy of a
				certification roster of attendance and self-study courses submitted for not less
				than four (4) years from the date the course is completed.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-42 - Continuing Education for Individual Insurance Producers and Individual Insurance Adjusters › Section 114-42-8 - Disciplinary Process

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. No later than
				sixty (60) days prior to the end of the reporting period, the Commissioner shall
				provide written notification to individual insurance producers and individual
				insurance adjusters subject to continuing insurance education requirements advising
				them as to the status of their continuing insurance education credits.
8.1.1. The Commissioner shall provide the
				notification to each individual insurance producer or individual insurance adjuster
				by electronic mail or by regular mail, if requested, addressed to the individual
				insurance producer at the last respective address appearing for the individual
				insurance producer in the records of the Commissioner.
8.1.2. Individual insurance producers who sell
				only preneed burial insurance contracts shall file with the Commissioner an
				affidavit, on a form to be provided by the Commissioner, verifying that the
				individual insurance producer is not engaged in the sale of any other type of
				insurance product.
8.1.3. Individual
				insurance producers engaged solely in telemarketing insurance products by a scripted
				presentation which has been filed with and approved by the Commissioner shall file
				an affidavit, on a form to be provided by the Commissioner, verifying that the
				individual insurance producer is not engaged in the sale of any other type of
				insurance product.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43 - Health Maintenance Organization › Section 114-43-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				applies to all persons or entities which are licensed or which may be required to be
				licensed pursuant to the provisions of W. Va. Code '33-25A-1 et
				seq.
1.2. Authority. -- W. Va. Code
''33-25A-3(3) 5, 20.
1.3. Filing Date. -- April 3, 1996.
1.4. Effective Date. -- April 3, 1996.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43 - Health Maintenance Organization › Section 114-43-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Administrative
				health service contract" means an agreement between a certificate of authority
				holder and a health service intermediary or between health service intermediaries in
				which:
a. The intermediary accepts payments,
				including payments on a fixed per capita fixed aggregate sum or percentage of
				premium basis, from the certificate of authority holder or from another health
				service intermediary for one or more health care services to be rendered by
				providers to subscribers, members, policyholders, or certificate-holders, as
				applicable, of a certificate of authority holder, where the intermediary assumes
				financial risk for payments to providers; and
b. The intermediary contracts with providers to
				render one or more health care services to subscribers, policyholders or
				certificateholders, as applicable, of a certificate of authority holder.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43 - Health Maintenance Organization › Section 114-43-4 - HMO Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Upon
				entry of a health service intermediary contract, a certificate of authority holder
				shall immediately file with the commissioner a full executed copy of the contract
				and all exhibits, attachments, addenda, schedules or other documents relevant to the
				contract.
a. Upon filing a health service
				intermediary contract with the commissioner, the certificate of authority holder
				shall simultaneously file the opinion of a qualified independent actuary which
				expresses the opinion of the qualified independent actuary that the entry of the
				contract by the certificate of authority holder:
A. Is a fiscally and financially sound
				transaction;
B. Does not cause excessive
				payments to the intermediary;
C.
				Provides for reasonable incentives to the intermediary for cost control;
				and
D. Does not contribute to the
				escalation of the cost of providing health care to enrollees.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43 - Health Maintenance Organization › Section 114-43-5 - Guarantees

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. A health service
				intermediary's obligations, pursuant to paragraphs 3.1.d and 3.1.e. may be fulfilled
				by the unconditional, irrevocable guarantee of a parent, sister or affiliated entity
				which:
a. Has been in operation for five years or
				more and has a surplus on a West Virginia statutory accounting basis, not including
				land, buildings, and equipment, of greater than $2 million. In any determination of
				the financial condition of the guaranteeing operation, investments in or loans to
				any organizations guaranteed by the guaranteeing organization shall be excluded from
				surplus. If the guaranteeing organization is sponsoring more than one organization,
				the surplus requirement shall be increased by a multiple equal to the number of
				organizations;
b. Submits a guarantee
				that is approved by the commissioner in writing as meeting the requirements of this
				section. The written guarantee must contain a provision which requires that the
				guarantee be irrevocable unless the guaranteeing organization can demonstrate to the
				commissioner that the cancellation of the guarantee will not result in the
				insolvency of the intermediary and the commissioner approves in writing the
				cancellation of the guarantee;
c.
				Initially submits its audited financial statements, certified by an independent
				certified public accountant, prepared in accordance with generally accepted
				accounting principles, covering its two most current annual accounting periods; and
d. Submits annually, within three (3)
				months after the end of its fiscal year, an audited financial statement certified by
				an independent certified public accountant, prepared in accordance with generally
				accepted accounting principles. The commissioner may, as he or she considers
				necessary, require quarterly financial statements from the guaranteeing
				organization.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43 - Health Maintenance Organization › Section 114-43-6 - Separability

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. If any provision of
				this rule is held invalid, the remainder of this rule shall not be affected
				thereby.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43A - Provider Sponsored Networks › Section 114-43A-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				provides for the licensing and regulation of provider sponsored networks.
1.2. Authority. -- W. Va. Code §
									33-25G-5 (2012).
1.3. Filing Date.- May 17, 2013.
1.4. Effective Date.- May 17, 2013.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43A - Provider Sponsored Networks › Section 114-43A-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. This rule applies
				to any applicant for a certificate of authority from the Commissioner to operate in
				this state as a provider sponsored network and to any entity to which such a
				certificate has been granted.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43A - Provider Sponsored Networks › Section 114-43A-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. "Commissioner"
				means the West Virginia Insurance Commissioner.
3.2. "Federally Qualified Health Center" or "FQHC"
				means an entity as defined in 42 U.S.C. §1396 d(1)(2)(B).
3.3. "Medicaid beneficiary" means any person
				participating, through either a state plan amendment or waiver authority, in any
				Medicaid program administered by the West Virginia Department of Health and Human
				Resources or its Bureau for Medical Services.
3.4. "Participating provider" means a licensed
				health care provider who has entered into a contract with a provider sponsored
				network to provide services to Medicaid enrollees.
3.5. "Provider sponsored network" or "PSN" means
				an entity that satisfies the definition of a "Medicaid managed care organization"
				set forth in 42 U.S.C. §1396 b(m)(1)(A), is controlled by one or more FQHCs,
				and provides or otherwise makes available health care services solely to Medicaid
				beneficiaries pursuant to contract with the Secretary executed in accordance with
				W.Va. Code §
									16-2L-1
et
				seq.
3.6. "Secretary" means the
				Secretary of the West Virginia Department of Health and Human Resources.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-43A - Provider Sponsored Networks › Section 114-43A-5 - Regulation as an HMO

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. PSNs are subject to
				all statutes, rules and other legal bases for the regulation of HMOs by the
				Commissioner, except to the extent any such statutes, rules or other legal bases for
				regulation are expressly made inapplicable to PSNs or are superseded by an
				applicable federal law or regulation.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule establishes minimum reserve standards for all individual and group
				health [accident and sickness] insurance coverages, except credit
				insurance.
1.2. Authority. -- W. Va.
				Code ''33-2-10 and 33-7-9(m).
1.3.
				Filing Date. -- April 2, 1996.
1.4.
				Effective Date. -- April 2, 1996.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-2 - Purpose

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. The purpose of this
				rule is to establish the minimum reserve standards for individual and group health
				(accident and sickness) insurance coverages.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-3 - Scope

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. When an insurer
				determines that the adequacy of its health insurance reserves requires reserves in
				excess of the minimum standards specified in this rule, the increased reserves shall
				be held and shall be considered the minimum reserves for that insurer.
3.2. With respect to any block of contracts, or
				with respect to an insurer's health business as a whole, a prospective gross premium
				valuation is the ultimate test of reserve adequacy as of a given valuation date. The
				gross premium valuation shall take into account, for contracts in force, in a claims
				status, or in a continuation of benefits status on the valuation date, the present
				value as of the valuation date of: all expected benefits unpaid, all expected
				expenses unpaid, and all unearned or expected premiums, adjusted for future premium
				increases reasonably expected to be put into effect.
3.3. The insurer is to perform a gross premium
				valuation whenever a significant doubt exists as to reserve adequacy with respect to
				any major block of contracts, or with respect to the insurer's health business as a
				whole. In the event inadequacy is found to exist, immediate loss recognition shall
				be made and the reserves restored to adequacy. Adequate reserves (inclusive of
				claim, premium and contract reserves, if any) shall be held with respect to all
				contracts, regardless of whether contract reserves are required for the contracts
				under the standards in this rule.
3.4.
				Whenever minimum reserves, as defined in this rule, exceed reserve requirements as
				determined by a prospective gross premium valuation, the minimum reserves remain the
				minimum requirement under this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-4 - Categories of Reserves

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. This rule
				establishes minimum standards for three categories of health insurance reserves:
				claims reserves, premium reserves and contract reserves.
4.2. The adequacy of an insurer's health insurance
				reserves is to be determined on the basis of all three categories combined. However,
				this rule emphasizes the importance of determining appropriate reserves for each of
				the three categories separately.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-5 - Appendices

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. This rule contains
				two appendices which are an integral part of the standards, and one additional
				"supplementary" appendix which is not part of the standards as such, but is included
				for explanatory and illustrative purposes only.
a.
				Appendix A sets forth specific minimum standards with respect to morbidity,
				mortality and interest, which apply to claim reserves according to year of incurral
				and to contract reserves according to year of issue.
b. Appendix B sets forth a glossary of technical
				terms used.
c. Appendix C is a
				supplementary appendix which establishes standards for reserves taking into
				consideration waiver of premium.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-6 - Claim Reserves

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. General.
a. Claim reserves are required for all incurred
				but unpaid claims on all health insurance policies.
b. Appropriate claim expense reserves are required
				with respect to the estimated expense of settlement of all incurred but unpaid
				claims.
c. All claim reserves for prior
				valuation years are to be tested for adequacy and reasonableness along the lines of
				claim runoff schedules in accordance with the statutory financial statement
				including consideration of any residual unpaid liability.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-7 - Premium Reserves

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. General.
a. Unearned premium reserves are required for all
				contracts with respect to the period of coverage for which premiums, other than
				premiums paid in advance, have been paid beyond the date of valuation.
b. If premiums due and unpaid are carried as an
				asset, the premiums must be treated as premiums in force, subject to unearned
				premium reserve determination. The value of unpaid commissions, premium taxes, and
				the cost of collection associated with due and unpaid premiums must be carried as an
				offsetting liability.
c. The gross
				premiums paid in advance for a period of coverage commencing after the next premium
				due date which follows the date of valuation may be appropriately discounted to the
				evaluation date and shall be held either as a separate liability or as an addition
				to the unearned premium reserve which would otherwise be required as a
				minimum.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-8 - Contract Reserves

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. General.
a. Contract reserves are required, unless
				otherwise specified in paragraph b of this subsection for:
A. All individual and group contracts with which
				level premiums are used; or
B. All
				individual and group contracts with respect to which, due to the gross premium
				pricing structure at issue, the value of the future benefits at any time exceeds the
				value of any appropriate future valuation net premiums at that time. The values
				specified in this subparagraph shall be determined on the basis specified in
				subsection 8.2 of this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-9 - Reinsurance

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Increases to, or
				credits against reserves carried, arising because of reinsurance assumed or
				reinsurance ceded, must be determined in a manner consistent with the minimum
				reserve standards set forth in this rule and with all applicable provisions of the
				reinsurance contracts which affect the insurer's liabilities.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Section 114-44-10 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. If any provision
				of this rule or the application of this rule to any person or circumstances is for
				any reason held to be invalid, the remainder of the rule and the application of the
				provisions to other persons or circumstances shall not be affected by the
				holding.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-44 - Minimum Reserve Standards For Individual And Group Health Insurance Contracts › Appendix C - RESERVES FOR WAIVER OF PREMIUM (Supplementary explanatory material)

Current through Register Vol. XLI, No. 28, July 12, 2024
Waiver of premium reserves involve several special considerations.
				  First, the disability valuation tables promulgated by the NAIC are based on
				  exposures that include contracts on premium waiver as in-force contracts. Hence,
				  contract reserves based on these tables are NOT reserves on "active lives" but
				  rather reserves on contracts "in force." This is true for the 1964 CDT and for both
				  the 1985 CIDA and CIDB tables.
Accordingly, tabular reserves using any of these tables should
				  value reserves on the following basis:
Claim reserves should include reserves for premiums expected to be
				  waived, valuing as a minimum the valuation net premium being waived.
Premium reserves should include contracts on premium waiver as
				  in-force contracts, valuing as a minimum the unearned modal valuation net premium
				  being waived.
Contract reserves should include recognition of the waiver of
				  premium benefit in addition to other contract benefits provided for, valuing as a
				  minimum the valuation net premium to be waived.
If an insurer is, instead, valuing reserves on what is truly an
				  active life table, or if a specific valuation table is not being used but the
				  insurer's gross premiums are calculated on a basis that includes in the projected
				  exposure only those contracts for which premiums are being paid, then it may not be
				  necessary to provide specifically for waiver of premium reserves. Any insurer using
				  such a true "active life" basis should carefully consider, however, whether or not
				  additional liability should be recognized on account of premiums waived during
				  periods of disability or during claim continuation.
_
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 114-45-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				Legislative rule applies to all life insurance companies and fraternal benefit
				societies doing business in this State and to all life insurance companies and
				fraternal benefit societies which are authorized to reinsure life insurance,
				annuities or accident and health insurance business in this State. This rule is
				based upon the National Association of Insurance Commissioners' "Model Rule For
				Recognizing a New Annuity Mortality Table For Use In Determining Reserve Liabilities
				For Annuities (Model 821)," as amended in 2012.
1.2. Authority. -- W. Va. Code §§
									33-2-10,
				33-7-9a and
				33-7-9(e)(2),(3) and
				(5).
1.3. Filing Date. -- April 24, 2015.
1.4. Effective Date. -- July 23, 2015.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 114-45-2 - Purpose

Current through Register Vol. XLI, No. 28, July 12, 2024
The purpose of this rule is to recognize the following mortality
				  tables for use in determining the minimum standard of valuation for annuity and pure
				  endowment contracts: the 1983 table "a"; the 1983 Group Annuity Mortality (1983 GAM)
				  Table; the Annuity 2000 Mortality Table; the 2012 Individual Annuity Reserving (2012
				  IAR) Table, and the 1994 Group Annuity Reserving (1994 GAR) Table.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 114-45-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. As used in this
				rule, "1983 Table 'a'" means that mortality table developed by the Society of
				Actuaries Committee To Recommend a New Mortality Basis for Individual Annuity
				Valuation and adopted as a recognized mortality table for annuities in June 1982 by
				the National Association of Insurance Commissioners.
3.2. As used in this rule, "1983 GAM Table" means
				that mortality table developed by the Society of Actuaries Committee on Annuities
				and adopted as a recognized mortality table for annuities in December 1983 by the
				National Association of Insurance Commissioners.
3.3. As used in this rule, "1994 GAR Table" means
				that mortality table developed by the Society of Actuaries Group Annuity Valuation
				Table Task Force and shown on pages 866-867 of Volume XLVII of the
Transactions of the Society of Actuaries
(1995).
3.4. As used in this rule, "Annuity 2000 Mortality
				Table" means that morality table developed by the Society of Actuaries Committee on
				Life Insurance Research and shown on page 240 of Volume XLVII of the
Transactions of the Society of Actuaries
(1995).
3.5. As used in this rule, "Period table" means a
				table of mortality rates applicable to a given calendar year (the Period).
3.6. As used in this rule, "Generational mortality
				table" means a mortality table containing a set of mortality rates that decrease for
				a given age from one year to the next based on a combination of a Period table and a
				projection scale containing rates of mortality improvement.
3.7. As used in this rule "2012 IAR Table" means
				that Generational mortality table developed by the Society of Actuaries Committee on
				Life Insurance Research and containing rates,
				qx2012+n, derived from a
				combination of the 2012 IAM Period Table and Projection Scale G2, using the
				methodology stated in section 5.
3.8. As
				used in this rule, "2012 Individual Annuity Mortality Period Life (2012 IAM Period)
				Table" means the Period table containing loaded mortality rates for calendar year
				2012. This table contains rates,
				qx2012, developed by the Society
				of Actuaries Committee on Life Insurance Research and is shown in Appendices
				I-II.
3.9. As used in this rule,
				"Projection Scale G2 (Scale G2)" is a table of annual rates,
				G2X, of mortality improvement by age for projecting future
				mortality rates beyond calendar year 2012. This table was developed by the Society
				of Actuaries Committee on Life Insurance Research and is shown in Appendices
				III-IV.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 114-45-4 - Individual Annuity or Pure Endowment Contracts

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Except as provided in subsections 4.2 and 4.3
				of this section, the 1983 Table "a" is recognized and approved as an individual
				annuity mortality table for valuation and, at the option of the life insurance
				company or fraternal benefit society, may be used for purposes of determining the
				minimum standard of valuation for any individual annuity or pure endowment contract
				issued on or after April 6,1977.
4.2.
				Except as provided in subsection 4.3 of this section, either the 1983 Table "a" or
				the Annuity 2000 Mortality Table shall be used for determining the minimum standard
				of valuation for any individual annuity or pure endowment contract issued on or
				after January 1,1997.
4.3. Except as
				provided in subsection 4.4 of this section, the Annuity 2000 Mortality Table shall
				be used for determining the minimum standard of valuation for any individual annuity
				or pure endowment contract issued on or after April 1, 1999.
4.4. Except as provided in subsection 4.5 of this
				section, the 2012 IAR Mortality Table shall be used for determining the minimum
				standard of valuation for any individual annuity or pure endowment contract issued
				on or after August 1,2015.
4.5. The 1983
				Table "a" without projection is to be used for determining the minimum standards of
				valuation for an individual annuity or pure endowment contract issued on or after
				April 1, 1999, solely when the contract is based on life contingencies and is issued
				to fund periodic benefits arising from:
4.5.a.
				Settlements of various forms of claims pertaining to court settlements or out of
				court settlements from tort actions;
4.5.b. Settlements involving similar actions such
				as worker's compensation claims; or
4.5.c. Settlements of long term disability claims
				where a temporary or life annuity has been used in lieu of continuing disability
				payments.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 114-45-5 - Application of the 2012 IAR Mortality Table

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				In using the 2012 IAR Mortality Table, the mortality rate for a person age x in year
				(2012 + n) is calculated as follows:
Click Here To
				  View Image
5.2. The
				resulting qx2012+n shall be
				rounded to three decimal places per 1,000, e.g., 0.741 deaths per 1,000. Also, the
				rounding shall occur according to the formula above, starting at the 2012 period
				table rate.
5.3. For example, for a male
				age 30, qx2012 = 0.741.
Click Here To
				  View Image
Click Here To
				  View Image
5.4. A
				method leading to incorrect rounding would be to calculate
				qx2014 as
				qx2013 * (1 -0.010), or 0.734 *
				0.99 = 0.727.
5.5. It is incorrect to
				use the already rounded qx2013 to
				calculate qx2014.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 114-45-6 - Group Annuity or Pure Endowment Contracts

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Except as provided in subsections 6.2 and 6.3 of this section, the 1983 GAM Table,
				the 1983 Table "a," and the 1994 GAR Table are recognized and approved as group
				annuity mortality tables for valuation and, at the option of the life insurance
				company or fraternal benefit society, any one of these tables may be used for
				purposes of valuation for any annuity or pure endowment purchased on or after April
				6,1977 under a group annuity or pure endowment contract.
6.2. Except as provided in subsection 6.3 of this
				section, either the 1983 GAM Table or the 1994 GAR Table shall be used for
				determining the minimum standard of valuation for any annuity or pure endowment
				purchased on or after January 1,1997 under a group annuity or pure endowment
				contract.
6.3. The 1994 GAR Table shall
				be used for determining the minimum standard of valuation for any annuity or pure
				endowment purchased on or after April 1,1999 under a group annuity or pure endowment
				contract.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 114-45-7 - Application of the 1994 GAR Table

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. In using
				the 1994 GAR Table, the mortality rate for a person age x in year (1994 + n) is
				calculated as follows:
Click Here To
				  View Image
where the qx1994
				  and AAxs are as specified in the 1994 GAR
				  Table.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-45 - Recognizing Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Appendix I

Current through Register Vol. XLI, No. 28, July 12, 2024
2012 IAM Period Table Female, Age Nearest Birthday
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
0
1.621
30
0.300
60
3.460
90
88.377
1
0.405
31
0.321
61
3.916
91
97.491
2
0.259
32
0.338
62
4.409
92
107.269
3
0.179
33
0.351
63
4.933
93
118.201
4
0.137
34
0.365
64
5.507
94
130.969
5
0.125
35
0.381
65
6.146
95
146.449
6
0.117
36
0.402
66
6.551
96
163.908
7
0.110
37
0.429
67
7.039
97
179.695
8
0.095
38
0.463
68
7.628
98
196.151
9
0.088
39
0.504
69
8.311
99
213.150
10
0.085
40
0.552
70
9.074
100
230.722
11
0.086
41
0.600
71
9.910
101
251.505
12
0.094
42
0.650
72
10.827
102
273.007
13
0.108
43
0.697
73
11.839
103
295.086
14
0.131
44
0.740
74
12.974
104
317.591
15
0.156
45
0.780
75
14.282
105
340.362
16
0.179
46
0.825
76
15.799
106
362.371
17
0.198
47
0.885
77
17.550
107
384.113
18
0.211
48
0.964
78
19.582
108
400.000
19
0.221
49
1.051
79
21.970
109
400.000
20
0.228
50
1.308
80
24.821
110
400.000
21
0.234
51
1.308
81
28.351
111
400.000
22
0.240
52
1.460
82
32.509
112
400.000
23
0.245
53
1.613
83
37.329
113
400.000
24
0.247
54
1.774
84
42.830
114
400.000
25
0.250
55
1.950
85
48.997
115
400.000
26
0.256
56
2.154
86
55.774
116
400.000
27
0.261
57
2.399
87
63.140
117
400.000
28
0.270
58
2.700
88
71.066
118
400.000
29
0.281
59
3.054
89
79.502
119
400.000
120
1000.000