reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-2 - Definitions

Current through July 13, 2024
(a) For the purposes of this Regulation:
				"Associate member of an employee organization" means any individual who
				participates in an employee benefit plan (as defined in
				29
				U.S.C. §
										1002(1) ) that
				is a multi-employer plan (as defined in
				29
				U.S.C. §
										1002(37A) ),
				other than the following:
(i) An individual,
				or the beneficiary of such individual, who is employed by a participating
				employer within a bargaining unit covered by at least one of the collective
				bargaining agreements under or pursuant to which the employee benefit plan is
				established or maintained; or
(ii)
				An individual who is a present or former employee, or a beneficiary of such
				employee, of the sponsoring employee organization, of an employer who is or was
				a party to at least one of the collective bargaining agreements under or
				pursuant to which the employee benefit plan is established or maintained, or of
				the employee benefit plan or of a related plan.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-3 - Applicability and Scope

Current through July 13, 2024
(a) This Regulation shall apply to any health
				benefit plan, whether provided on a group or individual basis, which:
(i) Meets one or more of the conditions set
				forth in W.S. §
										
											26-19-303;
(ii) Provides coverage to two or more
				eligible employees of a small employer, without regard to whether the policy or
				certificate was issued in this state; and
(iii) Is in effect on or after the effective
				date of W.S. §
										
											26-19-301 et seq.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-4 - Establishment of Classes of Business

Current through July 13, 2024
(a) A small employer carrier that establishes
				more than one class of business as defined in W.S. §
									
										26-19-302(a)(vii) shall
				maintain on file for inspection by the Commissioner the following information:
(i) A description of each criterion employed
				by the carrier (or any of its agents) for determining membership in the class
				of business;
(ii) A statement
				describing the justification for establishing a separate class of business, and
				documentation substantiating differences in expected claims experience or
				administrative costs; and
(iii) A
				statement disclosing which, if any, health benefit plans are available in the
				class and any significant limitations related to the purchase of such
				plans.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-5 - Transition for Assumptions of Business from Another Carrier

Current through July 13, 2024
(a) A small employer carrier shall not
				transfer or assume the entire insurance obligation and/or risk of a health
				benefit plan covering a small employer in Wyoming unless:
(i) The transaction has been approved by the
				Commissioner of the state of domicile of the assuming carrier;
(ii) The transaction has been approved by the
				Commissioner of the state of domicile of the ceding carrier; and
(iii) The transaction otherwise meets the
				requirements of this section.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-6 - Restrictions Relating to Premium Rates

Current through July 13, 2024
(a) A small employer carrier shall develop a
				separate rate manual for each class of business. Base premium rates and new
				business premium rates charged to small employers by the small employer carrier
				shall be computed solely from the applicable rate manual developed pursuant to
				this subsection. To the extent that a portion of the premium rates charged by a
				small employer carrier is based on the carrier's discretion, the manual shall
				specify the criteria and factors considered by the carrier in exercising such
				discretion. The carrier shall also provide the Commissioner, upon request, the
				rate manual and any additional information or documentation specified in this
				Section.
(i) A small employer carrier that
				modifies the rating method used in the rate manual for a class of business
				shall maintain with the rate manual for a period of six (6) years information
				and documentation containing the following:
(A) The reasons the change in rating method
				is being modified;
(B) A complete
				description of each of the proposed modifications to the rating
				method;
(C) A description of how
				the change in rating method would affect the premium rates currently charged to
				small employers in the class of business, including an estimate from a
				qualified actuary of the number of groups or individuals (and a description of
				the types of groups or individuals) whose premium rates may change by more than
				ten percent (10%) due to the proposed change in rating method (not generally
				including increases in premium rates applicable to all small employers in a
				health benefit plan);
(D) A
				certification from a qualified actuary that the new rating method would be
				based on objective and credible data and would be actuarially sound and
				appropriate; and
(E) A
				certification from a qualified actuary that the proposed change in rating
				method would not produce premium rates for small employers that would be in
				violation of W.S. §
											
												26-19-304.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-8 - Consideration of Industry

Current through July 13, 2024
(a) Except as provided in subsections (b) and
				(c), a small employer carrier may not consider the trade or occupation of the
				employees of a small employer or the industry or type of business in which the
				small employer is engaged in determining whether to issue or continue to
				provide coverage to the small employer.
(b) A small employer carrier may use industry
				as a case characteristic in establishing premium rates, subject to applicable
				federal and state law.
(c) A small
				employer carrier may consider trade, occupation or industry as part of the
				eligibility criteria for a class of business, subject to applicable federal and
				state law.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-9 - Application to Re-enter State

Current through July 13, 2024
(a) A carrier that has been prohibited from
				writing coverage for small employers in Wyoming pursuant to W.S. §
									
										26-19-305(c) may not resume
				offering health benefit plans to small employers in Wyoming until the carrier
				has made a petition and has been approved by the Commissioner.
(b) In the case of a small employer carrier
				doing business in only one established geographic service area of Wyoming, if
				the small employer carrier elects to nonrenew a health benefit plan under W.S.
				§
									
										26-19-305(a)(vi), the small
				employer carrier shall be prohibited from offering health benefit plans to
				small employers in any part of the service area for a period of five (5) years.
				In addition, the small employer carrier shall not offer health benefit plans to
				small employers in any other geographic area of the state without the prior
				approval of the Commissioner.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-10 - Qualifying Previous and Qualifying Existing Coverage

Current through July 13, 2024
(a) For the purposes of W.S. §
									
										26-19-302(a)(xv) and
				26-19-306(c)(ii),
				an individual will be considered to have previous or existing coverage if the
				previous or existing policy, certificate or other benefit arrangement met the
				relevant definition of Section 2(c) of this Regulation. The small employer
				carrier shall interpret W.S. §
									
										26-19-301 et seq. and this Regulation no less
				favorably to an insured individual than the following:
(i) A health insurance policy, certificate or
				other health benefit arrangement shall be considered employer-based if an
				employer sponsors the plan or arrangement or makes a contribution to the plan
				or arrangement.
(ii) A health
				insurance policy, certificate or other benefit arrangement shall be considered
				to provide benefits similar to or exceeding the benefits provided under the
				basic health benefit plan if it provides benefits that:
(A) Have an actuarial value as considered for
				a normal distribution of groups that is not substantially less than the
				actuarial value of the basic health benefit plan; or
(B) Provides coverage for hospitalization and
				physician services that is substantially similar to or exceeds the coverage for
				such services in the basic health benefit plan.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-11 - Restrictive Riders and Rates

Current through July 13, 2024
(a) Except as permitted in applicable federal
				and state law, a small employer carrier shall not modify or restrict a basic or
				standard health benefit plan in any manner for the purposes of restricting or
				excluding coverage or benefits for specific diseases, medical conditions or
				services otherwise covered by the plan.
(b) Except as permitted in applicable federal
				and state law, a small employer carrier shall not modify or restrict any health
				benefit plan with respect to any eligible employee or dependent of an eligible
				employee if dependent coverage is offered, through riders, endorsements or
				otherwise, for the purpose of restricting or excluding the coverage or benefits
				provided to such employee or dependent if dependent coverage is offered for
				specific diseases, medical conditions or services otherwise covered by the
				plan.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-12 - Rules Related to Fair Marketing

Current through July 13, 2024
(a) A small employer carrier shall actively
				market each of its health benefit plans in Wyoming. A small employer carrier
				may not suspend the marketing or issuance of the basic and standard health
				benefit plans unless the carrier has good cause and has received the prior
				approval of the Commissioner.
(b)
				In marketing the basic and standard health benefit plans, a small employer
				carrier shall use at least the same sources and methods of distribution that it
				uses to market other health benefit plans. Any producer authorized by a small
				employer carrier to market health benefit plans in Wyoming shall also be
				authorized to market the basic and standard health benefit plans.
(c) A small employer carrier shall actively
				offer all health benefit plans actively marketed in Wyoming to any small
				employer that applies for or makes an inquiry regarding health insurance
				coverage. The offer shall be in writing and the offer may be provided directly
				to the small employer or delivered through a producer and shall include at
				least the following information:
(i) A
				general description of the benefits contained in the basic and standard
				healthbenefit plans and any other health benefit plan being offered to the
				small employer; and
(ii)
				Information describing how the small employer may enroll in the
				plans.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-14 - Rules Related to Fair Marketing

Current through July 13, 2024
(a)
(i) A small employer carrier shall actively
				market each of its health benefit plans to small employers in this state. A
				small employer carrier may not suspend the marketing or issuance of the basic
				and standard health benefit plans unless the carrier has good cause and has
				received the prior approval of the Commissioner.
(ii) In marketing the basic and standard
				health benefit plans to small employers, a small employer carrier shall use at
				least the same sources and methods of distribution that it uses to market other
				health benefit plans to small employers. Any producer authorized by a small
				employer carrier to market health benefit plans to small employers in the state
				shall also be authorized to market the basic and standard health benefit
				plans.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-15 - Status of Carriers as Small Employer Carriers

Current through July 13, 2024
(a)
(i) Within sixty (60) days after the
				effective date of this Regulation, each carrier providing health benefit plans
				in this state that has not filed with the commissioner the basic and standard
				plans pursuant to W.S. §
										
											26-19-306(b) shall make a
				filing with the Commissioner indicating whether the carrier intends to operate
				as a small employer carrier in this state under the terms of this
				Regulation.
(ii) Carriers that have
				filed with the commissioner the basic and standard plans pursuant to W.S.
				§
										
											26-19-306(b) shall be
				considered as operating as a small employer carrier in the state.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Section 49-16 - Continuation

Current through July 13, 2024
(a) Continuation of coverage shall be made
				available to any eligible employee or dependent of an eligible employee who has
				been continuously covered by the health benefit plan during the entire three
				(3) month period ending with the termination of eligibility. Continuation must
				be made available to the eligible employee regardless of whether or not the
				covered dependents elect to continue coverage under W.S. §
									
										26-19-113 and this regulation. Continuation
				must be made available to dependents of eligible employees who terminate
				employment or membership or eligibility regardless of whether or not the
				eligible employee continues coverage as provided in W.S. §
									
										26-19-113 and this regulation.
(b) Former eligible employees or their
				dependents of the group that are continuing their coverage are not to be
				counted towards fulfilling that group's minimum participation
				requirements.
(c) The small group
				employer solely shall designate to whom the payment of premiums are to be made.
				This designation shall be made at the time continuation of coverage is elected.
				This designation shall be done in writing and be delivered to the former
				eligible employee who is electing to continue coverage as set forth in W.S.
				§
									
										26-19-113.
(d) The former eligible employee or the
				dependent of a former eligible employee must notify the small employer of his
				or her desire to continue coverage as set forth in W.S. §
									
										26-19-113. The notification must be within
				thirty-one (31) days after the expiration of coverage. This notification shall
				also include the former eligible employee's and\or dependent's election to
				continue dental, vision or other benefits that are in addition to the hospital,
				surgical, or other major medical benefits that were in the small employer group
				policy. This election can be made only once, and the decision is irrevocable
				after the election.
(e) Grace
				period provisions that apply to former eligible employees who are continuing
				their coverage shall not be more restrictive than the grace period provisions
				that apply to the small employer group policy in which they were previously
				enrolled.
(f) For the purposes of
				this section, "former eligible employees" shall be defined as an eligible
				employee or dependent who has lost coverage under the small employer health
				benefit plan and is eligible to enroll for continuation of coverage, or who is
				currently continuing coverage as set forth in W.S. §
									
										26-19-113.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 49 - REGULATION TO IMPLEMENT THE SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT › Appendix A - ACTUARIAL CERTIFICATION

Current through July 13, 2024
TO: SMALL EMPLOYER HEALTH INSURANCE COMPLIANCE
				  DIVISION
FROM: (Please type or print)
NAME OF COMPANY: ___________________
NAIC NUMBER: _________________
NAME OF CONTACT PERSON: ______________________
TITLE: __________________
TELEPHONE NUMBER: ____________________________
DATE: __________________
ADDRESS: _______________________________
_______________________________
_______________________________
_______________________________
I. Actuarial Certification:
I hereby certify that the rates charged small groups in the
				  state of Wyoming are:
1. Based on rating methods that are actuarially sound;
2. Such that the index rate for any class of business does
				  not exceed the index rate for another class of business by more than twenty
				  percent (20%);
3. Such that rates for small employers with similar
				  characteristics within a class of business do not vary from the index rate by
				  more than thirty-five percent (35%);
4. Such that the percentage increase in the premium rate for
				  a renewal rating period does not exceed the sum of the following:
(a) The percentage change in the new business premium rate
				  measured from the first day of the prior rating period to the first day of the
				  new rating period, or the percentage change in the base premium rate in the
				  case of a class of business for which the insurer is not issuing new
				  policies,
(b) An adjustment of not more than fifteen (15%) annually,
				  adjusted pro rata for shorter rating periods, for such rating factors as claim
				  experience, health status, and duration of coverage, determined in accordance
				  with the [name of small employer carrier] rate manual or renewal rating
				  guidelines, and
(c) An adjustment for a change in case characteristics or in
				  benefit design characteristics, determined in accordance with the [name of
				  small employer carrier] rate manual and rating procedure.
5. Such that the rate factor associated with any industry
				  classification does not vary from the arithmetic average of the rate factors
				  associated with all industry classifications by greater than fifteen percent
				  (15%) of such coverage; and
6. In compliance with all other facets of
				  W.S.
				  26-19-301 through 310, based upon the
				  examination of premium rates for applicable health benefit plans and the review
				  of their underlying actuarial assumptions and methods.
I certify that sufficient documentation of compliance is on
				  file with the [name of small employer carrier] and available upon request by
				  the Commissioner of Insurance.
_________________
Signature
Name ( Typed or printed) ________________
Title (Typed or Printed) _______________
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-1 - Authority

Current through July 13, 2024
This regulation is promulgated pursuant to
				  W.S.
				  26-5-116(a),
				  26-2-110(a)
				  and
				  16-3-101
et seq
.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-2 - Purpose

Current through July 13, 2024
The purpose of this regulation is to set forth rules and
				  procedural requirements which the Wyoming Insurance Commissioner deems
				  necessary to carry out the provisions of
				  W.S.
				  26-5-111 through
				  26-5-117
				  of the Insurance Code. The actions and information required by this regulation
				  are declared to be necessary and appropriate in the public interest and for the
				  protection of the ceding insurers in this state.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-3 - Severability

Current through July 13, 2024
If any provision of this regulation, or the application of
				  the provision to any person or circumstance, is held invalid, the remainder of
				  the regulation, and the application of the provision to persons or
				  circumstances other than those to which it is held invalid, shall not be
				  affected.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-4 - Credit for Reinsurance - Reinsurer Licensed in this State

Current through July 13, 2024
Pursuant to
				  W.S.
				  26-5-112(a)(i), the
				  commissioner shall allow credit for reinsurance ceded by a domestic insurer to
				  an assuming insurer that was licensed in this state as of any date on which
				  statutory financial statement credit for reinsurance is claimed.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-5 - Credit for Reinsurance - Accredited Reinsurers

Current through July 13, 2024
(a) Pursuant to
				W.S.
				26-5-112(a)(ii), the
				commissioner shall allow credit for reinsurance ceded by a domestic insurer to
				an assuming insurer which is accredited as a reinsurer in this state as of the
				date on which statutory financial statement credit for reinsurance is claimed.
				An accredited reinsurer shall:
(i) File a
				properly executed Form AR-1 (located at the Department of Insurance website,
				doi.wyo.gov) as evidence of its submission to this state's jurisdiction and to
				this state's authority to examine its books and records;
(ii) File with the commissioner a certified
				copy of a certificate of authority or other acceptable evidence that it is
				licensed to transact insurance or reinsurance in at least one state, or, in the
				case of a United States branch of an alien assuming insurer, is entered through
				and licensed to transact insurance or reinsurance in at least one
				state;
(iii) File annually with the
				commissioner a copy of its annual statement filed with the Insurance Department
				of its state of domicile or, in the case of an alien assuming insurer, with the
				state through which it is entered and in which it is licensed to transact
				insurance or reinsurance, and a copy of its most recent audited financial
				statement; and
(iv) Maintain a
				surplus in an amount not less than $20,000,000 or obtain the affirmative
				approval of the commissioner upon a finding that it has adequate financial
				capacity to meet its reinsurance obligations and is otherwise qualified to
				assume reinsurance from domestic insurers.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-6 - Credit for Reinsurance - Reinsurer Domiciled and Licensed in Another State

Current through July 13, 2024
(a) Pursuant to
				W.S.
				26-5-112(a)(iii) the
				commissioner shall allow credit for reinsurance ceded by a domestic insurer to
				an assuming insurer which as of the date on which statutory financial statement
				credit for reinsurance is claimed:
(i) Is
				domiciled in (or, in the case of a United States branch of an alien assuming
				insurer, is entered through) a state which employs standards regarding credit
				for reinsurance substantially similar to those applicable under
				W.S.
				26-5-111 through
				26-5-117
				and this regulation;
(ii) Maintains
				a surplus as regards policyholders in an amount not less than $20,000,000;
				and
(iii) Files a properly executed
				Form AR-1 with the commissioner as evidence of its submission to Wyoming's
				authority to examine its books and records.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-10 - Credit for Reinsurance Required by Law

Current through July 13, 2024
Pursuant to
				  W.S.
				  26-5-112(a)(iv) the
				  commissioner shall allow credit for reinsurance ceded by a domestic insurer to
				  an assuming insurer not meeting the requirements of
				  W.S.
				  26-5-112(a)(i), (ii), (iii), (v), (vi), or
				  (vii) but only with respect to the insurance
				  of risks located in jurisdictions where such reinsurance is required by the
				  applicable law or regulation of that jurisdiction. As used in this section,
				  "jurisdiction" means any state, district or territory of the United States and
				  any lawful national government.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-11 - Reduction from Liability for Reinsurance Ceded to an Unauthorized Assuming Insurer not Meeting the Requirements of Sections 4 Through 10

Current through July 13, 2024
(a) Pursuant to
				W.S.
				26-5-113 the commissioner shall allow a
				reduction from liability for reinsurance ceded by a domestic insurer to an
				assuming insurer not meeting the requirements of
				W.S.
				26-5-112 in an amount not exceeding the
				liabilities carried by the ceding insurer. The reduction shall be in the amount
				of funds held by or on behalf of the ceding insurer, including funds held in
				trust for the exclusive benefit of the ceding insurer, under a reinsurance
				contract with such assuming insurer as security for the payment of obligations
				under the reinsurance contract. The security shall be held in the United States
				subject to withdrawal solely by, and under the exclusive control of, the ceding
				insurer or, in the case of a trust, held in a qualified United States financial
				institution as defined in
				W.S.
				26-5-114(b). This security
				may be in the form of any of the following:
(i) Cash.
(ii) Securities listed by the Securities
				Valuation Office of the NAIC, including those deemed exempt from filing as
				defined by the Purposes and Procedures Manual of the Securities Valuation
				Office, and qualifying as admitted assets.
(iii) Clean, irrevocable, unconditional, and
				"evergreen" letters of credit issued or confirmed by a qualified United States
				institution, as defined in
				W.S.
				26-5-114(a) effective no
				later than December 31 of the year for which filing is being made, and in the
				possession of or in trust for the ceding insurer on or before the filing date
				of its annual statement. Letters of credit meeting applicable standards of
				issuer acceptability as of the dates of their issuance or confirmation shall,
				notwithstanding the issuing or confirming institution's subsequent failure to
				meet applicable standards of issuer acceptability, continue to be acceptable as
				security until their expiration, extension, renewal, modification or amendment,
				whichever first occurs; or any other form of security acceptable to the
				commissioner.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-12 - Trust Agreements Qualified Under Section 11

Current through July 13, 2024
(a) As used in this section:
(i) "Beneficiary" means the entity for whose
				sole benefit the trust has been established and any successor of the
				beneficiary by operation of law. If a court of law appoints a successor in
				interest to the named beneficiary, then the named beneficiary includes and is
				limited to the court-appointed domiciliary receiver including conservator,
				rehabilitator or liquidator.
(ii)
				"Grantor" means the entity that has established a trust for the sole benefit of
				the beneficiary. When established in conjunction with a reinsurance agreement,
				the grantor is the unlicensed, unaccredited assuming insurer.
(iii) "Obligations", as used in Subsection
				(b)(xi) of this section, means:
(A) Reinsured
				losses and allocated loss expenses paid by the ceding company, but not
				recovered from the assuming insurer;
(B) Reserves for reinsured losses reported
				and outstanding;
(C) Reserves for
				reinsured losses incurred but not reported; and
(D) Reserves for allocated reinsured loss
				expenses and unearned premiums.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-14 - Other Security

Current through July 13, 2024
A ceding insurer may take credit for unencumbered funds
				  withheld by the ceding insurer in the United States subject to withdrawal
				  solely by the ceding insurer and under its exclusive control.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-15 - Reinsurance Contract

Current through July 13, 2024
(a) Credit will not be granted, nor an asset
				or reduction from liability allowed, to a ceding insurer for reinsurance
				effected with assuming insurers meeting the requirements of sections
				4,
				5,
				6,
				7,
				8,
				9 or
				11 of this regulation or otherwise in
				compliance with
				W.S.
				26-5-112 after the adoption of this
				regulation unless the reinsurance agreement:
(i) Includes a proper insolvency clause,
				which stipulates that reinsurance is payable directly to the liquidator or
				successor without diminution regardless of the status of the ceding company,
				pursuant to
				W.S.
				26-5-115;
(ii) Includes a provision pursuant to W.S.
				W.S.
				26-5-112(c) whereby the
				assuming insurer, if an unauthorized assuming insurer, has submitted to the
				jurisdiction of an alternative dispute resolution panel or court of competent
				jurisdiction within the United States, has agreed to comply with all
				requirements necessary to give the court or panel jurisdiction, has designated
				an agent upon whom service of process may be effected, and has agreed to abide
				by the final decision of the court or panel; and
(iii) Includes a proper reinsurance
				intermediary clause, if applicable, which stipulates that the credit risk for
				the intermediary is carried by the assuming insurer.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 50 - CREDIT FOR REINSURANCE REGULATION › Section 50-16 - Contracts Affected

Current through July 13, 2024
All new and renewal reinsurance transactions entered into
				  after the effective date of this rule shall conform to the requirements of W.S.
				  26-5111 through
				  
										26-5-117 and this regulation if credit is to
				  be given to the ceding insurer for such reinsurance.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-1 - Authority

Current through July 13, 2024
This regulation is promulgated pursuant to W.S. §§
									
										26-2-110,
				  26-15-127,
				  16-3-101
et
				  seq
.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-2 - Definitions

Current through July 13, 2024
As used in this regulation:
(a) "ASC X12N" and any future iterations,
				standard format means the standards for electronic data interchange within the
				health care industry developed by the Accredited Standards Committee X12N
				Insurance Subcommittee of the American National Standards Institute.
(b) "CDT Procedure Codes" means the current
				dental terminology prescribed by the American Dental Association.
(c) "CPT Codes" means the physicians' current
				procedural terminology published by the American Medical Association.
(d) "HCFA" means the Health Care Financing
				Administration of the U.S. Department of Health and Human Services.
(e) "HCFA Form 1450" means the health
				insurance claim form maintained by HCFA for use by institutional care
				practitioners.
(f) "HCFA Form 1500"
				means the health insurance claim form maintained by HCFA for use by health care
				practitioners.
(g) "HCPCS" means
				HCFA's Common Procedure Coding System, a coding system which describes
				products, supplies, procedures and health professional services and includes,
				the American Medical Associations (AMA's) Physician Current Procedural
				Terminology codes, alphanumeric codes, and related modifiers. This includes:
(i) "HCPCS Level 1 Codes" which are the AMA's
				CPT codes and modifiers for professional services and procedures.
(ii) "HCPCS Level 2 Codes" which are national
				alpha-numeric codes and modifiers for health care products and supplies, as
				well as some codes for professional services not included in the AMA's
				CPT.
(iii) "HCPCS Level 3 Codes"
				which are local alpha-numeric codes and modifiers for items and services not
				included in HCPCS Level 1 or HCPCS Level 2.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-3 - Applicability and Scope

Current through July 13, 2024
(a) Except as otherwise specifically
				provided, the requirements of this regulation apply to issuers, health care
				practitioners, and institutional care practitioners.
(b) Nothing in this regulation shall prevent
				an issuer from requesting additional information that is not contained on the
				forms required under this regulation to determine eligibility of the claim for
				payment if required by applicable statutes, rules or regulations or required
				under the terms of the policy or certificate issued to the claimant.
(c) Nothing in this regulation shall prohibit
				an issuer, health care practitioner, or institutional care practitioner from
				using alternative procedures for filing claims as are specified in an existing
				written contract between the health care practitioner or institutional care
				practitioner and issuer.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-4 - Requirements for Use of HCFA Form 1500

Current through July 13, 2024
(a) Health care practitioners shall use the
				HCFA Form 1500 and instructions provided by HCFA for use of the HCFA Form 1500
				when filing claims with issuers for professional services. Health care
				practitioners that bill patients directly shall provide a properly completed
				HCFA Form 1500 in addition to any other explanatory information used to bill
				the patient when requested by the patient.
(b) Issuers may only require health care
				practitioners to use the following coding system and/or descriptors for the
				initial filing of claims for health care services:
(i) HCPCS Codes;
(ii) ICD-CM Codes;
(iii) In the case of Workers' Compensation,
				specific body part and other information used for the coding of charges;
				and
(iv) NDC codes for
				pharmaceuticals supplied by physicians and home health agency.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-5 - Requirements for Use of HCFA Form 1450

Current through July 13, 2024
(a) Institutional care practitioners shall
				use the HCFA Form 1450 and instructions provided by HCFA for use of the HCFA
				Form 1450 when filing claims with issuers for health care services.
				Institutional care providers that bill patients directly shall provide a
				properly completed HCFA Form 1450 in addition to any other explanatory
				information used to bill the patient when requested by the patient.
(b) Issuers may only require institutional
				care practitioners to use the following coding system for the initial filing of
				claims for health care services:
(i) ICD--CM
				Codes;
(ii) Revenue
				Codes;
(iii) HCPCS Codes;
				and
(iv) The information outlined
				in Section
				5 of this regulation if the charges include
				direct services furnished by a health care practitioner and the direct services
				are not covered by the instructions for the HCFA form 1450.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-6 - Requirements for Use of J5xx ADA Form; CDT Procedure Codes

Current through July 13, 2024
(a) Dentists shall use the J5xx Form and
				instructions provided by the American Dental Association for filing claims with
				issuers for professional services. Dentists that bill patients directly shall
				provide a properly completed J5xx Form in addition to any other form used to
				bill the patient when requested by the patient.
(b) Issuers may not require a dentist to use
				any code other than the CDT Procedure Codes for the initial filing of claims
				for dental care services, unless the use of supplemental codes are defined and
				permitted in a written contract between the issuer and dentist. Clearly defined
				supplemental codes may be used only for procedures not elsewhere defined by CDT
				Procedure Codes.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-7 - General Provisions

Current through July 13, 2024
(a) Health care practitioners and
				institutional care practitioners shall file claims in a manner consistent with
				the requirements of this regulation. Claims filed in paper form shall be
				printed on 8.5 x 11 inch paper.
(b)
				Issuers shall accept forms submitted in compliance with this regulation for the
				processing of claims.
(c) Health
				care practitioners, institutional care practitioners, and issuers shall:
(i) Use and accept the most current editions
				of the HCFA Form 1500, HCFA Form 1450, or J5xx Form and the most current
				instructions for these forms in the billing of patients or their
				representatives and filing claims with issuers.
(ii) Modify their billing and claim
				reimbursement practices to encompass the coding changes for all billing and
				claim filing by the effective date of the changes set forth by the developers
				of the forms, codes, and procedures required under this regulation.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-8 - Mandatory Electronic Format

Current through July 13, 2024
Unless otherwise provided by federal or state law, issuers
				  that elect to receive claims or elect to send payments by electronic means
				  shall support the NSF for electronic media claims and electronic remittance
				  notice (ERN) as an interim standard format until the American National
				  Standards Institute (ANSI) ASC X12N standard format for the health care claims
				  submission transaction set (837) and the ASC X12N health care claim payment
				  transaction set (835) or their successors become the required standard
				  formats.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 51 - UNIFORM HEALTH CLAIM FORMS REGULATION › Section 51-10 - 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 the 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 52 - CREDIT LIFE AND DISABILITY INSURANCE › Section 52-1 - Authority

Current through July 13, 2024
These regulations pertaining to Credit Life and Disability
				  Insurance supplement the provisions of Chapter 21, Wyoming Insurance Code. They
				  are promulgated by authority of and pursuant to the Wyoming Administrative
				  Procedure Acts
										16-3-101 et seq. and to the
				  Wyoming Insurance Code W.S. W.S.
				  W.S.
				  26-2-110,
				  26-2-125,
				  26-13-101 et seq.,
				  
										26-21-101 et seq.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 52 - CREDIT LIFE AND DISABILITY INSURANCE › Section 52-2 - Purpose

Current through July 13, 2024
The purpose of these rules is: to aid in the effectuation of
				  Chapter 21, Wyoming Insurance Code pertaining to Credit Life and Disability
				  Insurance, to limit commissions, to provide for filing of premium (rates), to
				  furnish certain statistical information and to define certain unfair methods of
				  competition and unfair trade practices.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 52 - CREDIT LIFE AND DISABILITY INSURANCE › Section 52-3 - Definitions

Current through July 13, 2024
As used herein, the following terms are thus defined:
(a) "Experience dividend or refund" is a form
				of commission whereby an agent of the insurer receives, directly or indirectly,
				money or any other thing of value in lieu of or in addition to a lawful agent's
				commission by reason of the mortality or morbidity experience of the insurer,
				or the profit of the insurer, by whatever means arrived at, on the insurer's
				policies sold by said agent.
(b)
				"Creditor agent' means a creditor, as defined herein, who is also an appointed
				agent of an insurer.
(c) "General
				agent means a duly appointed agent of the insurer who is an independent
				contractor on behalf of an insurer and who services and supervises other duly
				appointed agents of the insurer pursuant to an agreement with the insurer, and
				who is not affiliated in any way with a creditor or creditor agent, other than
				as a supervisor thereof No "general agent shall be a partner, firm member,
				associate, joint venturer, stockholder, corporation officer, director or
				employee of a "creditor agent nor shall the converse be allowed.
(i) "Person" shall have the meaning set forth
				in W.S. 26-l-102(a)(xx).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 52 - CREDIT LIFE AND DISABILITY INSURANCE › Section 52-4 - Collection and Remittance of Premiums

Current through July 13, 2024
A creditor may remit and an insurer may collect premiums on a
				  monthly balance basis if the insurance charges or premiums are not added to the
				  amount of the loan and do not constitute part of the outstanding indebtedness,
				  or if no direct or indirect, interest, finance, carrying, credit or service
				  charges are made to the debtor in connection with the insurance charges or
				  premiums. In those instances in which identifiable insurance charges or
				  premiums are added to the total amount of indebtedness and direct or indirect
				  interest, finance, carrying, credit or service charges are made thereon, the
				  creditor shall at the time of imposition of such additional interest or other
				  charge be deemed to have loaned the insurance charges or premiums to the debtor
				  and the premiums shall be deemed collected for the insurer at the time they are
				  added to the indebtedness, in which event the creditor shall remit and the
				  insurer shall collect on a single premium basis only.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 52 - CREDIT LIFE AND DISABILITY INSURANCE › Section 52-5 - Premium or Rate Filings

Current through July 13, 2024
In addition to those matters referred to in
				  W.S.
				  26-21-107(b), in passing
				  upon premium or rate filings, the Insurance Commissioner will give
				  consideration to available mortality and morbidity data pertaining to the
				  debtors of a creditor of a class or classes of debtors of a creditor, previous
				  experience, if any, for an actuarially credible period on such creditor's
				  debtors, including the experience of any subsidiary or affiliate of the
				  creditor, available age data and a reasonable rate of expense. Age data and
				  prior experience of the creditor's program should always be submitted.
Commissions or other payments, credits, dividends or
				  allowances to creditors, agents or general agents shall not be considered a
				  justification, or any part of a justification, of a higher premium as being
				  reasonable in relation to benefits.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 52 - CREDIT LIFE AND DISABILITY INSURANCE › Section 52-7 - Refunds

Current through July 13, 2024
W.S. 26-21-109(b)
				  Wyoming Insurance Code requires that refund formulae be filed with and approved
				  by the Commissioner. No refund formula may be utilized unless it is at least as
				  favorable to the insured debtor as a formula providing a pro rata refund of
				  premium. In no event need a refund or credit be made if the amount thereof is
				  less than one dollar.