reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-4 - Policy Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Except for
				permitted preexisting condition clauses as described in subdivision a of subsection
				5.2 of this rule, subdivision a of subsection 6.2 of this rule, and subdivision a of
				subsection 6A.2 of this rule, no policy or certificate may be advertised, solicited
				or issued for delivery in this state as a Medicare supplement policy if the policy
				or certificate contains limitations or exclusions on coverage that are more
				restrictive than those of Medicare.
4.2.
				No Medicare supplement policy or certificate may use waivers to exclude, limit or
				reduce coverage or benefits for specifically named or described preexisting diseases
				or physical conditions.
4.3. No Medicare
				supplement policy or certificate in force in the state shall contain benefits which
				duplicate benefits provided by Medicare.
4.4. Subject to subdivisions d, e and g,
				subsection 5.2 of this rule, and subdivisions d and e, subsection 6.2 of this rule,
				a Medicare supplement policy with benefits for outpatient prescription drugs in
				existence prior to January 1, 2006 shall be renewed for current policyholders who do
				not enroll in Part D at the option of the policyholder.
4.4.a. A Medicare supplement policy with benefits
				for outpatient prescription drugs shall not be issued after December 31,
				2005.
4.4.b. After December 31, 2005, a
				Medicare supplement policy with benefits for outpatient prescription drugs may not
				be renewed after the policyholder enrolls in Medicare Part D unless:
4.4.c. The policy is modified to eliminate
				outpatient prescription coverage for expenses of outpatient prescription drugs
				incurred after the effective date of the individual's coverage under a Part D plan
				and;
4.4.d. Premiums are adjusted to
				reflect the elimination of outpatient prescription drug coverage at the time of
				Medicare Part D enrollment, accounting for any claims paid, if applicable.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-7A - Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

Current through Register Vol. XLI, No. 28, July 12, 2024
7A.1.
				The following standards are applicable to all Medicare supplement policies or
				certificates delivered or issued for delivery in this state with an effective date
				of coverage on or after June 1, 2010. No policy or certificate may be advertised,
				solicited, delivered or issued for delivery in this state as a Medicare supplement
				policy or certificate unless it complies with these benefit plan standards. Benefit
				plan standards applicable to Medicare supplement policies and certificates issued
				with an effective date of coverage before June 1, 2010 remain subject to the
				requirements of sections 6 and 7 of this rule.
7A.2.
7A.2.a. An
				issuer shall make available to each prospective policyholder and certificate holder
				a policy form or certificate form containing only the basic core benefits as defined
				in subsection 6A.3 of this rule.
7A.2.b.
				If an issuer makes available any of the additional benefits described in subsection
				6A.4, or offers standardized benefit Plans K or L (as described in subdivisions h
				and i, subsection 7A.6 of this section), then the issuer shall make available to
				each prospective policyholder and certificate holder, in addition to a policy form
				or certificate form with only the basic core benefits as described in subdivision a
				of this subsection, a policy form or certificate form containing either standardized
				benefit Plan C (as described in subdivision c, subsection 7A.6 of this section) or
				standardized benefit Plan F (as described in subdivision e, subsection 7A.6 of this
				section).
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-7B - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020

Current through Register Vol. XLI, No. 28, July 12, 2024
7B.1. The Medicare Access and CHIP Reauthorization
				Act of 2015 (MACRA) requires the following standards are applicable to all Medicare
				supplement policies or certificates delivered or issued for delivery in this state
				to individuals newly eligible for Medicare on or after January 1, 2020. No policy or
				certificate that provides coverage of the Medicare Part B deductible may be
				advertised, solicited, delivered or issued for delivery in this state as a Medicare
				supplement policy or certificate to individuals newly eligible for Medicare on or
				after January 1, 2020. All policies must comply with the following benefit
				standards. Benefit plan standards applicable to Medicare supplement policies and
				certificates issued to individuals eligible for Medicare before January 1, 2020,
				remain subject to the requirements of sections 6A and 7A of this rule.
7B.2. Benefit Requirements. The standards and
				requirements of section 7A of this rule shall apply to all Medicare supplement
				policies or certificates delivered or issued for delivery to individuals newly
				eligible for Medicare on or after January 1, 2020, with the following exceptions:
7B.2.a. Standardized Medicare supplement benefit
				Plan C is redesignated as Plan D and shall provide the benefits contained in
				subdivision c, subsection 7A.6 of this rule but shall not provide coverage for one
				hundred percent (100%) or any portion of the Medicare Part B deductible.
7B.2.b. Standardized Medicare supplement benefit
				Plan F is redesignated as Plan G and shall provide the benefits contained in
				subdivision e, subsection 7A.6 of this rule but shall not provide coverage for one
				hundred percent (100%) or any portion of the Medicare Part B deductible.
7B.2.c. Standardized Medicare supplement benefit
				plans C, F, and F With High Deductible may not be offered to individuals newly
				eligible for Medicare on or after January 1, 2020.
7B.2.d. Standardized Medicare supplement benefit
				Plan F With High Deductible is redesignated as Plan G With High Deductible and shall
				provide the benefits contained in subdivision f, subsection 7A.6 of this rule but
				shall not provide coverage for one hundred percent (100%) or any portion of the
				Medicare Part B deductible; provided further that, the Medicare Part B deductible
				paid by the beneficiary shall be considered an out-of-pocket expense in meeting the
				annual high deductible.
7B.2.e. The
				reference to Plans C or F contained in subdivision b, subsection 7A.2 of this rule
				is deemed a reference to Plans D or G for purposes of this section.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-8 - Medicare Select Policies and Certificates

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. This section shall apply to Medicare Select
				policies and certificates, as defined in this section.
8.2. No policy or certificate may be advertised as
				a Medicare Select policy or certificate unless it meets the requirements of this
				section.
8.3. For the purposes of this
				section:
8.3.a. "Complaint" means any
				dissatisfaction expressed by an individual concerning a Medicare Select issuer or
				its network providers.
8.3.b.
				"Grievance" means dissatisfaction expressed in writing by an individual insured
				under a Medicare Select policy or certificate with the administration, claims
				practices, or provision of services concerning a Medicare Select issuer or its
				network providers.
8.3.c. "Medicare
				Select issuer" means an issuer offering, or seeking to offer, a Medicare Select
				policy or certificate.
8.3.d. "Medicare
				Select policy" or "Medicare Select certificate" mean respectively a Medicare
				supplement policy or certificate that contains restricted network
				provisions.
8.3.e. "Network provider"
				means a provider of health care, or a group of providers of health care, which has
				entered into a written agreement with the issuer to provide benefits insured under a
				Medicare Select policy.
8.3.f.
				"Restricted network provision" means any provision which conditions the payment of
				benefits, in whole or in part, on the use of network providers.
8.3.g. "Service area" means the geographic area
				approved by the Commissioner within which an issuer is authorized to offer a
				Medicare Select policy.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-9 - Open Enrollment

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. No issuer shall
				deny or condition the issuance or effectiveness of any Medicare supplement policy or
				certificate available for sale in this state, nor discriminate in the pricing of a
				policy or certificate because of the health status, claims experience, receipt of
				health care, or medical condition of an applicant in the case of an application for
				a policy or certificate that is submitted prior to or during the six (6) month
				period beginning with the first day of the first month in which an individual is
				both 65 years of age or older and is enrolled for benefits under Medicare Part B.
				Each Medicare supplement policy and certificate currently available from an insurer
				shall be made available to all applicants who qualify under this subsection without
				regard to age.
9.2. If an applicant
				qualifies under subsection 9.1 of this section and submits an application during the
				time period referenced in subsection 9.1 of this section, and, as of the date of
				application, has had a continuous period of creditable coverage of at least six (6)
				months, the issuer shall not exclude benefits based on a preexisting
				condition.
9.3. If the applicant
				qualifies under subsection 9.1 of this section and submits an application during the
				time period referenced in subsection 9.1 of this section and, as of the date of
				application has had a continuous period of creditable coverage that is less than six
				(6) months, the issuer shall reduce the period of any preexisting condition
				exclusion by the aggregate of the period of creditable coverage applicable to the
				applicant as of the enrollment date. The Secretary shall specify the manner of the
				reduction under this subsection.
9.4.
				Except as provided in subsections 9.2 and 9.3 of this section and sections 10 and 21
				of this rule, subsection 9.1 of this section shall not be construed as preventing
				the exclusion of benefits under a policy, during the first six (6) months, based on
				a preexisting condition for which the policyholder or certificate holder received
				treatment or was otherwise diagnosed during the six (6) months before the coverage
				became effective.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-10 - Guaranteed Issue for Eligible Persons

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1.
10.1.a. Eligible persons are those individuals
				described in subsection 10.2 of this section who seek to enroll under the policy
				during the period specified in subsection 10.3 of this section, and who submit
				evidence of the date of termination, disenrollment, or Medicare Part D enrollment
				with the application for a Medicare supplement policy.
10.1.b. With respect to eligible persons, an
				issuer shall not deny or condition the issuance or effectiveness of a Medicare
				supplement policy described in subsection 10.5 of this section that is offered and
				is available for issuance to new enrollees by the issuer, shall not discriminate in
				the pricing of a Medicare supplement policy because of health status, claims
				experience, receipt of health care, or medical condition, and shall not impose an
				exclusion of benefits based on a preexisting condition under a Medicare supplement
				policy.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-11 - Standards for Claims Payment

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. An
				issuer shall comply with Section 1882(c)(3) of the Social Security Act (as enacted
				by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA)
				1987, Pub. L. No. 100-203 ) by:
11.1.a. Accepting
				a notice from a Medicare carrier on dually assigned claims submitted by
				participating physicians and suppliers as a claim for benefits in place of any other
				claim form otherwise required and making a payment determination on the basis of the
				information contained in that notice;
11.1.b. Notifying the participating physician or
				supplier and the beneficiary of the payment determination;
11.1.c. Paying the participating physician or
				supplier directly;
11.1.d. Furnishing,
				at the time of enrollment, each enrollee with a card listing the policy name,
				number, and a central mailing address to which notices from a Medicare carrier may
				be sent;
11.1.e. Paying user fees for
				claim notices that are transmitted electronically or otherwise; and
11.1.f. Providing to the Secretary of Health and
				Human Services, at least annually, a central mailing address to which all claims may
				be sent by Medicare carriers.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-12 - Loss Ratio Standards and Refund or Credit of Premium

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Loss Ratio Standards.
12.1.a. A Medicare supplement policy form or
				certificate form shall not be delivered or issued for delivery unless:
12.1.a.1. The policy form or certificate form can
				be expected, as estimated for the entire period for which rates are computed to
				provide coverage, to return to policyholders and certificate holders in the form of
				aggregate benefits (not including anticipated refunds or credits) provided under the
				policy form or certificate form:
12.1.a.1.A. At
				least seventy-five percent (75%) of the aggregate amount of premiums earned in the
				case of group policies, or
12.1.a.1.B.
				At least sixty-five percent (65%) of the aggregate amount of premiums earned in the
				case of individual policies;
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-13 - Filing and Approval of Policies and Certificates and Premium Rates

Current through Register Vol. XLI, No. 28, July 12, 2024
13.1. An issuer shall not deliver or issue for
				delivery a policy or certificate to a resident of this state unless the policy form
				or certificate form has been filed with and approved by the Commissioner in
				accordance with filing requirements and procedures prescribed by the
				Commissioner.
13.2. An issuer shall file
				any riders or amendments to policy or certificate forms to delete outpatient
				prescription drug benefits as required by the Medicare Prescription Drug,
				Improvement, and Modernization Act of 2003 only with the commissioner in the state
				in which the policy or certificate was issued.
13.3. An issuer shall not use or change premium
				rates for a Medicare supplement policy or certificate unless the rates, rating
				schedule and supporting documentation have been filed with and approved by the
				Commissioner in accordance with the filing requirements and procedures prescribed by
				the Commissioner.
13.4. Except as
				provided in subdivision a of this subsection, an issuer shall not file for approval
				more than one form of a policy or certificate of each type for each standard
				Medicare supplement benefit plan.
13.4.a. An
				issuer may offer, with the approval of the Commissioner, up to four additional
				policy forms or certificate forms of the same type for the same standard Medicare
				supplement benefit plan, one for each of the following cases:
13.4.a.1. The inclusion of new or innovative
				benefits;
13.4.a.2. The addition of
				either direct response or agent marketing methods;
13.4.a.3. The addition of either guaranteed issue
				or underwritten coverage;
13.4.a.4. The
				offering of coverage to individuals eligible for Medicare by reason of
				disability.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-14 - Permitted Compensation Arrangements

Current through Register Vol. XLI, No. 28, July 12, 2024
14.1. An issuer or other entity may provide
				commission or other compensation to an agent or other representative for the sale of
				a Medicare supplement policy or certificate only if the first year commission or
				other first year compensation is no greater than two hundred percent (200%) of the
				commission or other compensation paid for selling or servicing the policy or
				certificate in the second year or period.
14.2. The commission or other compensation
				provided in subsequent (renewal) years must be the same as that provided in the
				second year or period and must be provided for no fewer than five (5) renewal
				years.
14.3. No issuer or other entity
				shall provide compensation to its agents or other producers and no agent or producer
				shall receive compensation greater than the renewal compensation payable by the
				replacing issuer on renewal policies or certificates if an existing policy or
				certificate is replaced.
14.4. For
				purposes of this section, "compensation" includes pecuniary or non-pecuniary
				remuneration of any kind relating to the sale or renewal of the policy or
				certificate including but not limited to bonuses, gifts, prizes, awards and finder's
				fees.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-17 - Filing Requirements for Advertising

Current through Register Vol. XLI, No. 28, July 12, 2024
An issuer shall provide a copy of any Medicare supplement
				  advertisement intended for use in this state whether through written, radio or
				  television medium to the Commissioner for review. The advertisement shall comply
				  with all laws of this state, including, when applicable, the provisions of W. Va.
				  Code §§
									33-6-8(e),
				  33-6-35,
				  and
				  33-11-4(2).
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-18 - Standards for Marketing

Current through Register Vol. XLI, No. 28, July 12, 2024
18.1. An issuer,
				directly or through its producers, shall:
18.1.a.
				Establish marketing procedures to assure that any comparison of policies by its
				agents or other producers will be fair and accurate.
18.1.b. Establish marketing procedures to assure
				excessive insurance is not sold or issued.
18.1.c. Display prominently by type, stamp or
				other appropriate means, on the first page of the policy the following:
"Notice to buyer: This policy may not cover all of your medical
				  expenses."
18.1.d. Inquire and
				otherwise make every reasonable effort to identify whether a prospective applicant
				or enrollee for Medicare supplement insurance already has accident and sickness
				insurance and the types and amounts of the insurance.
18.1.e. Establish auditable procedures for
				verifying compliance with this subsection.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-19 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through Register Vol. XLI, No. 28, July 12, 2024
19.1. In recommending the purchase or replacement
				of any Medicare supplement policy or certificate an agent shall make reasonable
				efforts to determine the appropriateness of a recommended purchase or
				replacement.
19.2. Any sale of a
				Medicare supplement policy or certificate that will provide an individual more than
				one Medicare supplement policy or certificate is prohibited.
19.3. An issuer shall not issue a Medicare
				supplement policy or certificate to an individual enrolled in Medicare Part C unless
				the effective date of the coverage is after the termination date of the individual's
				Part C coverage.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-20 - Reporting of Multiple Policies

Current through Register Vol. XLI, No. 28, July 12, 2024
20.1. On
				or before March 1 of each year, an issuer shall report the following information for
				every individual resident of this state for whom the issuer has in force more than
				one Medicare supplement policy or certificate:
20.1.a. Policy and certificate number,
				and
20.1.b. Date of issuance.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-21 - Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates

Current through Register Vol. XLI, No. 28, July 12, 2024
21.1. If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate, the
				replacing issuer shall waive any time periods applicable to preexisting conditions,
				waiting periods, elimination periods and probationary periods in the new Medicare
				supplement policy or certificate to the extent the time was spent under the original
				policy.
21.2. If a Medicare supplement
				policy or certificate replaces another Medicare supplement policy or certificate
				which has been in effect for at least six (6) months, the replacing policy shall not
				provide any time period applicable to preexisting conditions, waiting periods,
				elimination periods and probationary periods.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-22 - Prohibition Against Use of Genetic Information and Requests for Genetic Testing

Current through Register Vol. XLI, No. 28, July 12, 2024
22.1. This section
				applies to all policies with policy years beginning on or after May 21,
				2009.
22.2. An issuer of a Medicare
				supplement policy or certificate;
22.2.a. Shall
				not deny or condition the issuance or effectiveness of the policy or certificate
				(including the imposition of any exclusion of benefits under the policy based on a
				pre-existing condition) on the basis of the genetic information with respect to the
				individual; and
22.2.b. Shall not
				discriminate in the pricing of the policy or certificate (including the adjustment
				of premium rates) of an individual on the basis of the genetic information with
				respect to the individual.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				establishes standards for licensing and regulation of insurance adjusters. It is
				based on the National Association of Insurance Commissioners' "Public Adjusters
				Licensing Model Act (Model 228)" and "Independent Adjusters Licensing Model
				Guideline (Guideline 1224)," and the West Virginia Code.
1.2. Authority. -- W.Va. Code §§
									33-12B-12 and
				33-2-10.
1.3. Filing Date. -- April 12, 2021.
1.4. Effective Date. -- July 1, 2021.
1.5. Sunset Date. -- This rule shall terminate and
				have no further force or effect upon August 1, 2026.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-4 - Emergency Adjuster Licensing

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Upon
				declaration of an insurance emergency, a licensed insurer may apply to the
				Commissioner requesting the issuance of emergency licenses to persons designated in
				the application to act as emergency adjusters. The application shall be in the
				format on the Commissioner's website and shall be submitted electronically by the
				insurer.
4.2. A person who is otherwise
				qualified to adjust claims, but is not licensed in this state, may act as an
				emergency company or independent adjuster in this state if, within five days of the
				declared insurance emergency, the insurer notifies the Commissioner by completing a
				form on the Commissioner's website and providing the following information:
4.2.a. Name and address;
4.2.b. National Producer Number, if
				available;
4.2.c. Name of the insurer
				the adjuster will represent as an emergency adjuster;
4.2.d. Effective date of the contract between the
				insurer and independent adjuster, if applicable;
4.2.e. Insurance emergency or loss control number
				(e.g., Emergency Order 20-01);
4.2.f.
				Insurance emergency event name (e.g., 2016 flood or 2020 COVID-19 pandemic);
				and
4.2.g. Any other information the
				Commissioner deems necessary.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-5 - Types of Licenses and Lines of Authority

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				The types of adjuster's licenses which may be issued are as follows:
5.1.a. Company adjuster.
5.1.b. Public adjuster.
5.1.c. Independent adjuster.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-6 - Qualifications

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. No individual may
				hold a license as a resident adjuster unless he or she:
6.1.a. Is eighteen years of age or older;
6.1.b. Is a resident of West Virginia
				or eligible to designate West Virginia as his or her home state;
6.1.c. Satisfies the Commissioner that he or she
				is trustworthy and competent;
6.1.d. Has
				a business or mailing address in this state for acceptance of service of process or,
				if residing outside of this state, acknowledges that by adjusting claims in this
				state he or she is subject to the state's long-arm statute and automatically
				appoints the West Virginia Secretary of State as his or her agent for service of
				process;
6.1.e. Has not committed any
				act that is a ground for probation, suspension, revocation, or refusal of an
				adjuster's license as set forth in W.Va. Code §
										33-12B-11;
6.1.f. Has successfully passed the written
				examination for the line or lines of authority for which the person has applied;
				and
6.1.g. Has paid the applicable
				fees.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-7 - Application For Licensure

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Application for
				a company, public or independent adjuster's license shall be made to the
				Commissioner on forms prescribed by him or her and shall contain such information
				and be accompanied by such supporting documents as the Commissioner may require and,
				if so required by the Commissioner, shall be made under oath. The application shall
				provide which line of authority, or lines of authority, the adjuster is seeking to
				qualify for. The annual fee for an individual adjuster's license is $25 and shall be
				submitted with the application. The annual fee for a business entity adjuster's
				license is $200 and shall be submitted with the application.
7.2. Willful misrepresentation of any fact in any
				such application or in any documents in support thereof is a violation of chapter
				thirty-three of the Code and this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-8 - Public Adjuster Records Maintenance

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. A
				public adjuster shall maintain a complete record of each transaction as a public
				adjuster including:
8.1.a. Name of the
				insured;
8.1.b. Date, location and
				amount of loss;
8.1.c. Copy of the
				contract between the public adjuster and the insured;
8.1.d. Name of the insurer, amount, expiration
				date and number of each policy carried with respect to the loss;
8.1.e. Itemized statement of the insured's
				recoveries;
8.1.f. Itemized statement of
				all compensation received by the public adjuster, from any source whatsoever, in
				connection with the loss;
8.1.g. A
				register of all monies received, deposited, disbursed, or withdrawn in connection
				with a transaction with an insured, including fees transfers and disbursements from
				a trust account and all transactions concerning all interest bearing
				accounts;
8.1.h. Name of the public
				adjuster who executed the contract;
8.1.i. Name of the attorney representing the
				insured, if any, and the name of the claims representatives of the insurance
				company; and
8.1.j. Evidence of
				financial responsibility in a format prescribed by the
				Commissioner.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-9 - Standards of Conduct of Company and Crop Adjusters

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. The standards of conduct of company and
				independent adjusters are as follows:
9.1.a. A
				company or independent adjuster shall not give legal advice, and shall not deal
				directly with any policyholder or claimant who is represented by legal counsel,
				without the consent of the legal counsel involved.
9.1.b. A company or independent adjuster shall
				identify himself or herself as an independent contractor and, if applicable,
				identify his or her employer when dealing with any policyholder or
				claimant.
9.1.c. A company or
				independent adjuster shall identify his or her employer when dealing with any
				policyholder or claimant.
9.1.d. A
				company or independent adjuster shall not have any financial interest in any
				adjustment or acquire for himself or herself any interest or title in salvage,
				without first receiving written authority from the principal.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-10 - Standards of Conduct of Public Adjusters

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. Public adjusters shall adhere to the
				following standard of conduct:
10.1.a. A public
				adjuster is obligated to serve his or her client with objectivity and complete
				loyalty, and to render to the insured such information, counsel and service, as
				within the knowledge, understanding and opinion in good faith of the licensee, as
				will best serve the insured's insurance claim needs and interest;
10.1.b. A public adjuster shall not solicit, or
				attempt to solicit, an insured during the progress of a loss-producing occurrence,
				as defined in the insured's insurance contract;
10.1.c. A public adjuster shall not permit an
				unlicensed employee or representative of the public adjuster to conduct business for
				which a license is required under this article;
10.1.d. A public adjuster shall not have a direct
				or indirect financial interest in any aspect of the claim, other than the salary,
				fee, commission or other consideration established in the written contract with the
				insured, unless full written disclosure has been made to the insured as set forth in
				subsection 11.4 of this rule;
10.1.e. A
				public adjuster shall not acquire any interest in salvage of property subject to the
				contract with the insured unless the public adjuster obtains written permission from
				the insured after settlement of the claim with the insurer;
10.1.f. The public adjuster shall not refer or
				direct the insured to get needed repairs or services in connection with a loss
				unless the adjuster discloses to the insured whether the adjuster may receive direct
				or indirect compensation for the referral;
10.1.g. The public adjuster shall disclose to an
				insured if he or she has any interest or will be compensated by any construction
				firm, salvage firm, building appraisal firm, motor vehicle repair shop or any other
				person that performs any work in conjunction with damages caused by the insured
				loss; and
10.1.h. The source and amount
				of any compensation or thing of value received by the public adjuster in connection
				with an insured's loss shall be disclosed in writing to the insured.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-11 - Contract Between Public Adjuster and Insured

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. Public adjusters shall ensure that all
				contracts for their services are in a document entitled "Public Adjuster Contract"
				containing the following:
11.1.a. Full name of the
				adjuster signing the contract;
11.1.b.
				Permanent home state business address and phone number;
11.1.c. License number;
11.1.d. The insured's full name, street address,
				insurance company name and policy number;
11.1.e. A description of the loss and its
				location;
11.1.f. Description of
				services to be provided to the insured;
11.1.g. Signatures of the public adjuster and the
				insured and date(s) signed; and
11.1.h.
				Full salary, fee, commission, compensation or other considerations the public
				adjuster is to receive for services.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-12 - Public Adjuster Fees

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Any fee charged by
				a public adjuster must be reasonable.
12.2. A public adjuster shall not pay a
				commission, service fee or other valuable consideration to a person for
				investigating or settling claims in this state if that person is required to be
				licensed under this article and is not so licensed.
12.3. A person shall not accept a commission,
				service fee or other valuable consideration for investigating or settling claims in
				this state if that person is required to be licensed under this article and is not
				so licensed.
12.4. In the event of a
				catastrophe, no public adjuster shall charge, agree to or accept as compensation or
				reimbursement any payment, commission, fee, or other thing of value equal to more
				than ten percent of any insurance settlement or proceeds. No public adjuster shall
				require, demand or accept any fee, retainer, compensation, deposit, or other thing
				of value, prior to settlement of a claim.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-13 - Escrow or Trust Accounts

Current through Register Vol. XLI, No. 28, July 12, 2024
13.1. A public
				adjuster who receives, accepts or holds any funds on behalf of an insured towards
				the settlement of a claim for loss or damage shall deposit the funds in a
				non-interest bearing escrow or trust account in a financial institution that is
				insured by an agency of the federal government in the public adjuster's home state
				or where the loss occurred.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-14 - Assumed Names

Current through Register Vol. XLI, No. 28, July 12, 2024
14.1. An adjuster doing
				business under any name other than the adjuster's legal name is required to notify
				the Commissioner prior to using the assumed name.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-15 - Prohibited Practices; Voidable Contracts

Current through Register Vol. XLI, No. 28, July 12, 2024
15.1. A public adjuster shall not solicit or
				attempt to solicit employment during progress of a loss-producing occurrence nor
				while the fire department or its representatives are engaged at the damaged
				premises.
15.2. A public adjuster shall
				not collect or attempt to collect a fee or charge from a repair contractor for
				obtaining repair work for the contractor.
15.3. A public adjuster shall not advance money or
				any other valuable thing to an insured pending adjustment of a claim.
15.4. A public adjuster shall not provide his or
				her services to a client until the adjuster has contracted in writing with the
				insured or his or her authorized representative. A contract which is executed within
				forty-eight hours after conclusion of the loss producing occurrence shall be
				voidable at the option of the insured for ten days after execution of the contract.
				The written contract shall constitute the entire agreement between the adjuster and
				the insured and shall disclose all fees to be charged the insured by the public
				adjuster. A copy of the contract shall be given to the insured when the contract is
				executed.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-16 - Addresses of Adjusters; Filing

Current through Register Vol. XLI, No. 28, July 12, 2024
16.1. Each
				adjuster shall file with the Commissioner the complete address of his or her
				principal place of business and the complete address of his residence including the
				name and number of the street, or if the street where the business is located is not
				numbered, the number of the post office box. The Commissioner may require the filing
				of other information for the purposes of identifying the principal place of business
				and the place of residence.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-17 - Change of Address; Notice

Current through Register Vol. XLI, No. 28, July 12, 2024
17.1. Within thirty days
				of a change of business or residence address by an adjuster the adjuster must file
				with the Commissioner the current version of such information as is required by
				Section 16 of this rule. An adjuster's principal place of business may be either a
				home or a business address, but in either event, the adjuster must maintain such
				address as a permanent office.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-18 - Licensing of Nonresident Adjusters

Current through Register Vol. XLI, No. 28, July 12, 2024
18.1.
				An individual otherwise complying with the provisions of this rule who is a licensed
				adjuster in his or her home state, may apply with the Commissioner to become
				licensed as a nonresident company, public or independent adjuster in this state if
				his or her home state has established, by law or regulation requirements for the
				licensing of a resident of this state as a nonresident adjuster and if the
				applicant's home state awards nonresident licenses to residents of this state on the
				same basis. Such an individual is exempt from the examination requirements of W.Va.
				Code §
									33-12B-5
				if his or her home state required a substantially similar prelicensing examination.
				A resident of Canada may be licensed as a nonresident adjuster under this section if
				that person has obtained a resident or home state adjuster license in another United
				States jurisdiction.
18.2. The
				Commissioner may issue an adjuster's license to any applicant who is not a West
				Virginia resident and who cannot meet the requirements of subsection 18.1 of this
				rule if the applicant passes a written examination in West Virginia.
18.3. As a condition to the continuation of a
				nonresident adjuster license, the licensee shall maintain a resident adjuster
				license in his or her home state.
18.4.
				An individual who has obtained a nonresident adjuster license and who thereafter
				establishes legal residency in this state must make application within ninety (90)
				days to obtain a resident license for the same line of authority; such applicant is
				exempt from any prelicensing examination requirements.
18.5. An individual who has obtained a nonresident
				adjuster license and who has thereafter had his or her adjuster license suspended,
				terminated, or revoked by his or her home state must immediately notify the
				Commissioner of that regulatory action and, with respect to license terminations or
				revocations, surrender the nonresident adjuster license to the Commissioner. An
				individual who has had his or her home state license terminated or revoked is no
				longer eligible or qualified to continue to hold his or her nonresident adjuster
				license.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-19 - Expiration of License; Renewal

Current through Register Vol. XLI, No. 28, July 12, 2024
19.1. The
				Commissioner may fix the dates of expiration of respective licenses for all
				adjusters in any manner as is considered by him or her to be advisable for an
				efficient distribution of the workload of his or her office. If the expiration date
				so fixed would upon first occurrence shorten the period for which a license fee has
				theretofore been paid, no refund shall be made. If the expiration date so fixed
				would upon first occurrence lengthen the period for which license fee had
				theretofore been paid, the Commissioner shall charge no additional fee.
19.2. An adjuster who allows his or her license to
				lapse may have such license reinstated if he or she makes application within twelve
				months of the expiration date and pays a penalty in the amount of $25 in addition to
				any other fees.
19.3. The Commissioner
				may waive renewal requirements for an adjuster who is unable to comply due to
				military service, long-term disability or other extenuating circumstance.
19.4. Crop Adjusters that are renewing a license
				must show that they have maintained certification of proficiency issued or approved
				by the United States Department of Agriculture Risk Management Agency.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-26 - Accident And Sickness Rate Filing › Section 114-26-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule establishes requirements for information and data to be provided to
				the Insurance Commissioner with the filing of rates and rate adjustments for
				accident and sickness insurance policies. The purpose of this rule is to provide the
				Insurance Commissioner with the information necessary to ensure that rates for
				accident and sickness insurance are reasonable in relation to the benefits provided
				under the policy as required by W. Va. Code §§
									33-6-9(e)
				and
				33-16B-2. This
				rule applies to all individual accident and sickness insurance policy forms and all
				group accident and sickness insurance policy forms which are delivered or issued for
				delivery in this State which are not negotiated for with the policyholder and
				experience rated.
1.2. Authority. -- W.
				Va. Code §§
									33-2-10,
				33-6-9(e),
				33-16B-2.
1.3. Filing Date. -- April 16, 2004.
1.4. Effective Date. -- April 16, 2004.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-26 - Accident And Sickness Rate Filing › Section 114-26-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. A policy or policy
				form includes the contract effecting insurance, or the certificate thereof, and
				includes any riders, endorsements or amendments attached to the base
				contract.
2.2. An experience rated
				group, for purposes of this rule means a group eligible for group accident and
				sickness insurance pursuant to W. Va. Code §
									33-16-2 and whose
				premium rates are based on the historic and/or projected loss experience of the
				individual group standing alone.
2.3. A
				community rated group is a group eligible for group accident and sickness insurance
				pursuant to W. Va. Code §
									33-16-2 and whose
				premium rates are based on the historic and/or projected loss experience of a pool
				of group policies.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-26 - Accident And Sickness Rate Filing › Section 114-26-3 - Rate Filing Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1.
				General Requirements.
a. Every policy, rider or
				endorsement form which is submitted to the Commissioner for approval shall be
				accompanied by a rate filing if such policy, rider, or endorsement form in any way
				involves a new product which has not been previously approved or in any way effects
				a rate change. A reduction in benefits while maintaining the same rate shall be
				considered a rate change. Any subsequent additions to rate schedules or changes in
				rates applicable to such forms shall also be filed for approval.
b. Each rate filing shall include the appropriate
				filing fee, filing abstract(s), a cover letter explaining the nature of the filing,
				and all relevant information describing the basis on which the rates were determined
				and the calculations of the anticipated loss ratio. Interest, at a rate consistent
				with that assumed in the determination of premiums, shall be used in the calculation
				of the loss ratio.
c. Information
				required pursuant to this rule shall be provided in a format prescribed by the
				Insurance Commissioner.