West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-36 - West Virginia Life And Health Guaranty Association Act Notice Requirments › Section 114-36-3 - Form and Content of Summary Document

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Except with respect to a policy or contract
				to which subsection 3.6 applies, after October 8, 2009, no Member Insurer or its
				agent may deliver a Policy or Contract to a Policy or Contract Holder, unless the
				Summary Document as set forth in Appendix A is delivered to the Policy or Contract
				Holder prior to or at the time of delivery of the Policy or Contract. Provided, That
				for any policy or contract delivered between July 10, 2009 and October 7, 2009, the
				policy or contract holder shall be provided with a copy of the Summary Document
				prior to October 8, 2009.
3.2. The
				insurer or agent making the delivery of the Summary Document shall maintain a record
				of the delivery.
3.3. The Summary
				Document shall be printed on a separate sheet of paper. The Summary Document may not
				include the name and address of the Member Insurer issuing the Policy or Contract or
				the name and address of the agent who procured the Policy or Contract.
3.4. The Summary Document shall be identical to
				that prescribed by the Commissioner in Appendix A of this rule.
3.5 Delivery of the Summary Document set forth in
				Appendix A satisfies the requirements set forth in W. Va. Code §
									33-26A-19(b)
				and (c).
3.6. Delivery of the Notice set forth in Appendix
				B shall be made with respect to any policy or contract that is fully excluded from
				coverage under the Guaranty Association Act because it is not guaranteed by the
				insurer or the risk is borne by the policy or contract holder, and such delivery
				satisfies the requirements set forth in W. Va. Code §
									33-26A-19(d)
				with respect to any policy or contract delivered after October 7, 2009, to which
				such subsection applies: Provided, That for any policy or contract delivered between
				July 10 and October 7, 2009, the policy or contract holder shall be provided with a
				copy of the Notice prior to October 8, 2009.
3.7. Member Insurers and their agents that provide
				the following types of excluded coverages or services excluded from coverage under
				the West Virginia Life and Health Insurance Guaranty Act are not required to provide
				the Summary Document required by this rule to the contract or policy holders
				receiving the excluded coverages or services:
3.7.a. Any policy or contract of reinsurance,
				unless assumption certificates have been issued;
3.7.b. Any plan or program of an employer,
				association or similar entity to provide life, health or annuity benefits to its
				employees or members to the extent that the plan or program is self-funded or
				uninsured, including, but not limited to, benefits payable by an employer,
				association or similar entity under:
3.7.b.1. A
				multiple employer welfare arrangement as defined in section 514 of the Employee
				Retirement Income Security Act of 1974, as amended;
3.7.b.2. A minimum premium group insurance
				plan;
3.7.b.3. A stop-loss group
				insurance plan;
3.7.b.4. An
				administrative services only contract;
3.7.c. Any policy or contract issued in this state
				by a Member Insurer at a time when the member insurer was not licensed or did not
				have a certificate of authority to issue the policy or contract in West
				Virginia;
3.7.d. Any unallocated annuity
				contract issued to an employee benefit plan protected under the federal pension
				benefit guaranty corporation.