reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-73 - Small Employer Eligibility Requirements › Section 114-73-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to facilitate the offering of a health benefit plan under W.
				Va. Code §
									33-16D-16
				by any licensed carrier that accesses a health care provider network to deliver
				services, including health maintenance organizations, prepaid limited health
				services organizations, hospital service corporations, medical service corporations,
				dental service corporations, health service corporations and health care
				corporation, and to prevent manipulation by small employers of the criteria for
				determining eligibility to purchase a health benefit plan covered by W. Va. Code
				§
									33-16D-16.
1.2. Authority. -- W. Va. Code §§
									33-2-10 and
				33-16D-16(a)(4).
1.3. Filing Date. -- May 6, 2005.
1.4. Effective Date. -- May 6, 2005.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-73 - Small Employer Eligibility Requirements › Section 114-73-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Commissioner"
				means the West Virginia insurance commissioner.
2.2. "Health benefit plan" means a plan as defined
				in W. Va. Code §
									33-16D-1 a(h) and
				offered by a carrier at rates approved by the Commissioner pursuant to W. Va. Code
				§
									33-16D-16.
2.3. "Small employer" means employer as defined in
				W. Va. Code §
									33-16D-2(r).
2.4. "Carrier" means any health insurer, as
				defined in W. Va. Code §
									33-16D-2(s),
				that offers a health benefit plan to small employers at rates approved by the
				Commissioner pursuant to W. Va. Code §
									33-16D-16.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-73 - Small Employer Eligibility Requirements › Section 114-73-4 - Enforcement

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Suspected
				violations of this rule may be referred to the Commissioner's fraud unit pursuant to
				W. Va. Code §
									33-43-1 et seq. for
				investigation and other actions authorized thereunder.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-74 - Nonrenewal Of Property Insurance Policies › Section 114-74-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				addresses various aspects of the alternative percentage method for the nonrenewal of
				property insurance policies set forth in W. Va. Code §
									33-17A-4
				a (2005), including requirements for the nonrenewal notices, the establishment of
				the procedure for resolving complaints by persons whose property insurance policies
				have been nonrenewed and the filing of underwriting standards by insurers.
1.2. Authority. -- W. Va. Code §§
									33-2-10 and
				33-17A-4
				a (2005).
1.3. Filing Date. -- April 13,
				2006.
1.4. Effective Date. -- April 24,
				2006.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-74 - Nonrenewal Of Property Insurance Policies › Section 114-74-2 - Notice of Cancellation or Nonrenewal

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. All nonrenewal notices issued by insurers
				pursuant to W. Va. Code §
									33-17A-4
				a (2005) shall state the specific reason or reasons for refusal to renew and shall
				advise the insured that nonrenewal of the policy for any reason is subject to a
				hearing and review by the Insurance Commissioner as provided in W. Va. Code §
									33-17A-7
				(2005). The notice shall also advise the insured of possible eligibility for
				coverage through the West Virginia Essential Property Insurance Association or "Fair
				Plan." The written reason or reasons in a notice of nonrenewal must be sufficiently
				clear to be understood by a reasonable person; statements such as "underwriting
				reasons," "claims" or "increase in risk" will not be considered sufficiently clear.
				Nothing in this rule will prevent the insurer from providing more information in the
				notice relating to the reason or reasons for nonrenewal than is required by this
				section.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-74 - Nonrenewal Of Property Insurance Policies › Section 114-74-3 - Hearing Regarding Nonrenewal

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Hearing at
				request of policyholder or insurer. The commissioner shall review each complaint
				from every insured whose property insurance policy has been nonrenewed pursuant to
				the percentage method set forth in W. Va. Code §
									33-17A-4
				a and shall send to both the complainant and the insurer a notice as to whether the
				commissioner has found any violation of W. Va. Code §
									33-17A-4
				a(e). Within thirty (30) days of the date on which such notice was mailed, either
				party may demand a formal hearing before the commissioner.
3.2. Hearing called by Commissioner. If, after
				review of the complaint, the commissioner feels a hearing is necessary to resolve
				the complaint, he or she may call a hearing by virtue of the authority provided in
				W. Va. Code §
									33-2-13.
3.3. Hearing. The hearing, whether it be initiated
				by the complainant, the insurer or the commissioner, shall be conducted in
				accordance with the procedures set forth in 114 CSR 13. The subject matter of the
				hearing will be limited to the following issues:
a. Whether the nonrenewal notice provided at least
				thirty (30) days advance notice to the named insured of the insurer's intent to
				nonrenew the policy;
b. Whether the
				decision to refuse to renew was based on a discriminatory reason;
c. Whether the nonrenewal notice was based upon an
				underwriting standard found to be in violation of chapter thirty-three of the West
				Virginia Code; or
d. Whether the
				nonrenewal causes the insurer to exceed the percentage limitation set forth in W.
				Va. Code §
										33-17A-4
				a(d) for either the state or the county of the policyholder's residence.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-74 - Nonrenewal Of Property Insurance Policies › Section 114-74-4 - Filing of Underwriting Guidelines

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				Each insurer writing property insurance policies in this state shall file with the
				Commissioner a copy of its underwriting standards for property insurance and any
				subsequent modifications to the insurer's underwriting standards within thirty (30)
				business days after the modifications have been implemented. The commissioner will
				review these standards to ensure consistency with generally accepted underwriting
				principles.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-75 - Private Passenger Automobile And Property Insurance - Biannual Rate Filing Requirements › Section 114-75-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope -- This rule
				establishes guidelines and procedures under which every insurer providing five
				percent (5%) or more of the insurance in West Virginia for private passenger
				automobiles or property used for personal or family needs shall submit rate filings
				on a biannual basis.
1.2. Authority --
				W. Va. Code §§
									33-2-10 and
				33-20-4 a
				(2005).
1.3. Filing Date -- April 19,
				2006.
1.4. Effective Date -- April 24,
				2006.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-75 - Private Passenger Automobile And Property Insurance - Biannual Rate Filing Requirements › Section 114-75-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Insurers subject to
				biannual rate filing requirements. This rule applies to each insurer that provided
				five percent (5%) or more of the total insurance in West Virginia on either private
				passenger automobiles or on property used for personal or family needs.
a. "Insurance on private passenger automobiles"
				means a policy providing automobile liability insurance for a private passenger
				automobile.
b. "Property used for
				personal or family needs" means a policy providing property insurance which insures
				against loss of or damage to real property which is used predominantly for the
				residential purposes of the named insured, loss of or damage to personal property in
				which the named insured has an insurable interest where the personal property is
				used for personal, family or household purposes, and the personal property which is
				within a residential dwelling.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-75 - Private Passenger Automobile And Property Insurance - Biannual Rate Filing Requirements › Section 114-75-3 - Biannual Rate Filing Periods; Information Required To Be Reported

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Rate filing
				deadlines. Each insurer subject to the filing requirement shall submit a rate filing
				to the commissioner both on or before September 30 and on or before March 31 in the
				year subsequent to receipt of the notice issued in accordance to subsection 2.2 of
				this rule.
3.2. Rate filing
				requirements. Insurers shall submit rate filings in accordance with the provisions
				of W. Va. Code §
									33-20-4 and WV 114 CSR 67
				and shall include any other relevant information required by the
				commissioner.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-75 - Private Passenger Automobile And Property Insurance - Biannual Rate Filing Requirements › Section 114-75-4 - Penalties

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Failure to submit
				rate filing. Any insurer that fails to timely submit the rate filing specified in
				subsection 3.2 of this rule shall be fined one hundred dollars ($100.00) for each
				day the rate filing is late. The commissioner may waive or reduce this penalty if he
				or she determines that the failure to timely file was caused by excusable neglect;
				however, the assessment of a penalty under this section is automatic unless a waiver
				or reduction of the penalty is agreed to by the commissioner in writing.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-75 - Private Passenger Automobile And Property Insurance - Biannual Rate Filing Requirements › Section 114-75-5 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. If any provision of
				this rule is held invalid, the remainder of the rule shall not be affected
				thereby.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- These
				procedural rules shall govern the initiation and conduct of administrative
				proceedings before the Insurance Commissioner upon the filing of an administrative
				complaint by a third party claimant alleging an unfair claims settlement practice in
				violation of W. Va. Code §
									33-11-4(9)
				or WV 114 CSR 14.
1.2. Authority. -- W.
				Va. Code §§
									33-2-10 and
				33-11-4
				a(d).
1.3. Filing Date. -- March 28,
				2006.
1.4. Effective Date. -- April 27,
				2006.
1.5. These rules are intended to
				be read in conjunction with the procedural rule at WV 114 CSR 13. In the event of
				any conflict between the two rules, the provisions of this rule would
				control.
1.6. These rules are intended
				to compliment W. Va. Code §§
									29A-5-1
				et seq.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
The following definitions apply to this rule:
2.1. "Claimant" means a third party claimant as
				defined in WV 114 CSR 14-2.8.
2.2.
				"Commissioner" means the West Virginia Insurance Commissioner.
2.3. "Complaint" means an administrative complaint
				filed by a third party claimant pursuant to W. Va. Code §
									33-11-4
				a(b).
2.4. "Egregious act" means conduct
				that is fraudulent or malicious and reckless, whether or not the act constituted a
				pattern corresponding to an unfair claims settlement practice committed with such
				frequency as to constitute a general business practice. An act, or failure to act,
				that is due to negligence, lack of judgment, incompetence, or bureaucratic
				confusion, is not an egregious act.
2.5.
				"Natural person" means a human being, as distinguished from an artificial person
				created by law.
2.6. "Person" includes
				any individual, company, insurer, association, organization, society, reciprocal,
				business trust, corporation or any other legal entity, including agents, adjusters
				and brokers.
2.7. "Respondent" means a
				person(s) against whom a complaint is filed with the commissioner pursuant to W. Va.
				Code §
									33-11-4
				a(b).
2.8. "Sixty-day period" means the
				60-day period following the respondent's receipt of a complaint.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-3 - Representation of Claimants and Respondents

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Pro hac vice admission. -- Representation or
				appearance of parties in proceedings before the commissioner shall be only by
				attorneys at law admitted to practice before the courts of this state, before the
				courts of last resort of other states, or before the Supreme Court of the United
				States; Provided, That attorneys appearing before the commissioner who are not
				licensed to practice in West Virginia shall have sought and obtained permission to
				practice before the commissioner in compliance with Rule 8.0 of the Rules for
				Admission to the Practice of Law of the State of West Virginia. Documentation of
				permission granted by the West Virginia State Bar shall be supplied to the
				commissioner before such attorney files any pleading, motion or other paper or
				otherwise makes any appearance before the commissioner.
3.2. Pro se appearance. -- Any claimant who is a
				natural person may appear at and represent himself or herself in any matter before
				the commissioner.
3.3. Partner
				representing partnership. -- A partner may represent his or her partnership upon
				permission by the commissioner.
3.4.
				Representation of corporation. -- A corporate entity may be represented only by an
				attorney duly licensed or authorized to practice law in the state of West Virginia,
				although an employee of a corporation may testify at a hearing without the presence
				of counsel.
3.5. Representation by lay
				person prohibited. -- A party may not be represented in a matter before the
				commissioner by a spokesperson, lay representative or any other natural person not
				admitted or authorized to practice law in the state of West Virginia.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-4 - Filing of an Administrative Complaint

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				Time within which complaint must be filed. -- A written administrative complaint
				must be received by the commissioner no later than one (1) year following the actual
				or implied discovery of the alleged unfair claims settlement practice.
4.2. Receipt of complaint. -- For purposes of the
				time limit imposed by W. Va. Code §
									33-11-4
				a(b) and subsection 4.1 of this section, a complaint shall be deemed to have been
				received on the date on which a written document describing acts that could
				reasonably be construed as an unfair claims settlement practice is received by the
				commissioner, regardless of whether such document is on a form as described in
				subsection 4.3 of this section.
4.3.
				Complaint form. --
a. A complaint shall be on a
				form provided by the commissioner and shall state with specificity the following:
1. The statutory provision, if known, which the
				person allegedly violated;
2. The facts
				and circumstances giving rise to the violation;
3. The name of any individual or other entity
				involved in the violation;
4. Reference
				to specific policy language that is relevant to the violation, if known;
				and
5. Any other information the
				commissioner may require.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-5 - Resolution Without Hearing

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Closing of
				complaint. -- Except as provided in W. Va. Code §
									33-11-4
				a(i) and subsection 5.4 of this section, the commissioner shall close the complaint
				and no further action shall lie on the matter if he or she determines that the
				respondent:
a. Substantially corrected the
				circumstances that gave rise to the complaint within the sixty-day period;
b. Offered to resolve the complaint in a
				reasonable manner within the sixty-day period; or
c. Provided sufficient information to satisfy the
				commissioner that the complaint lacks merit.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-6 - Determination of Need For Hearing

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. When
				investigations may begin. -- Upon the expiration of the sixty-day period without a
				resolution of the complaint or a declaration by the respondent that he or she does
				not intend to take any further action to resolve the complaint within the sixty-day
				period, the commissioner may conduct any investigation he or she considers necessary
				to determine whether the allegations contained in the complaint are meritorious.
				Upon finding, after hearing, that an unfair claims settlement practice has been
				committed, the commissioner may also conduct an investigation to determine whether
				the unfair claims settlement practice was committed with such frequency as to
				constitute a general business practice.
6.2. Complaint provided to Office of Consumer
				Advocacy. -- If the complaint has not been closed pursuant to subsection 5.1 of this
				rule or has been reopened pursuant to subsection 5.3 of this rule, and the
				commissioner makes a preliminary finding that the complaint has merit, he or she
				shall forward a complete copy of the complaint and the respondent's response, if
				any, to the Office of Consumer Advocacy.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-7 - Hearings

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Scheduling of
				hearing. -- A hearing on a complaint shall be scheduled to be held within ninety
				(90) days from the date of filing the complaint, unless continued by agreement of
				all parties or by the commissioner for good cause. Good cause includes but is not
				limited to a determination by the commissioner that additional investigation is
				necessary.
7.2. Notice of hearing. --
				The commissioner shall assign a time and place for a hearing and shall mail written
				notice of the hearing to the parties at least ten (10) days in advance
				thereof.
7.3. Pre-hearing matters. --
				The provisions of WV 114 CSR 13.4 are specifically made applicable to proceedings
				under this rule.
7.4. Location of
				hearing. -- Hearings are to be conducted in the geographical region of the state
				where the complainant resides, as determined by the commissioner. Upon concurrence
				of all parties, the commissioner may conduct the hearing by telephone conference
				call.
7.5. Conduct of hearings.
a. To the extent such provisions are not in
				conflict with this rule, hearings shall be conducted in accordance with the
				procedures set forth in WV 114 CSR 13.
b. All testimony and evidence at any such hearing
				shall be reported by stenographic notes and characters or by mechanical
				means.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-8 - Commissioner's Authority

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Commissioner's
				authority not limited by rule. -- Nothing in this rule may be construed to limit the
				authority of the commissioner to conduct an investigation of or to take action
				against a respondent whom the commissioner has reason to believe has:
a. Intentionally committed an unfair claims
				settlement practice;
b. Committed an
				unfair claims settlement practice with such frequency as to constitute a general
				business practice; or
c. Consistently
				used the sixty-day period to resolve or settle third party claims.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-76 - Rules Of Practice And Procedure For Administrative Proceedings Brought By Third Pary Claimants › Section 114-76-9 - Penalties, Restitution and Judicial Review

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Penalties. -- If the commissioner determines
				after hearing that the respondent has committed an unfair claims settlement
				practice, he or she shall issue an order directing the respondent to cease and
				desist from such practice and may, in addition, impose one or more of the penalties
				as prescribed by W. Va. Code §
									33-11-6(a)
				through (d), inclusive.
9.2. Restitution. --
a. The commissioner may, in addition to any
				penalties imposed pursuant to subsection 9.1 of this section, grant restitution to
				the claimant if the commissioner determines that the claimant has suffered damages
				as a result of:
1. A general business practice;
				or
2. An egregious act committed by the
				respondent, regardless of whether the act occurred within a general business
				practice.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-77 - Rate Filing Requirements For Title Insurance Companies › Section 114-77-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				establishes guidelines and procedures under which title insurance companies shall
				submit rate filings.
1.2. Authority. --
				W. Va. Code §§
									33-2-10 and
				33-20-3(e)(2)(B)
				(2006).
1.3. Filing Date. -- April 6,
				2007.
1.4. Effective Date. -- April 6,
				2007.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-77 - Rate Filing Requirements For Title Insurance Companies › Section 114-77-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule sets forth the requirements for the filing of rates for
				  title insurance in this State. The requirements set forth in W. Va. Code
				  §§
									33-20-1
				  et seq. are applicable to title rate filings.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-77 - Rate Filing Requirements For Title Insurance Companies › Section 114-77-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this rule:
3.1. "Commercial" means any title insurance not
				meeting the definition of "non-commercial.
3.2. "Commissioner" means the West Virginia
				Insurance Commissioner.
3.3.
				"Noncommercial" means insurance that insures title to (a) property, other than
				property of a business or professional nature, which is used predominantly for
				residential, personal, family or household purposes; and (b) unimproved property
				that is intended for such purposes.
3.4
				"Title insurance" means insurance of owners of property or others having an interest
				therein, or liens or encumbrances thereon, against loss by encumbrance, defective
				title, invalidity or adverse claim to title.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-77 - Rate Filing Requirements For Title Insurance Companies › Section 114-77-4 - Information Required To Be Reported

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				Except to the extent they are inconsistent with this rule, rate filings for title
				insurance shall follow the procedures applicable to other rate filings pursuant to
				114 CSR 67.
4.2. Every rate filing by a
				title insurer shall differentiate between the rates proposed for commercial and
				non-commercial properties.
4.3. No title
				insurer may charge any rates after September 1, 2006 except in accordance with the
				premium rate schedule and manual filed with and approved by the Commissioner
				pursuant to this rule.
4.4. A title
				insurer or title insurance agent may satisfy its obligation to file premium rates,
				rating manuals and forms by becoming a member of or a subscriber to a rating
				organization licensed under the provisions of W. Va. Code §
									33-20-6 that
				makes filings on behalf of insurers: Provided, That nothing in this rule shall be
				construed as requiring any title insurer or title insurance agent to become a member
				of or a subscriber to any rating organization. Nothing in this rule prohibits any
				rating organization member or subscriber from making deviation filings in accordance
				with the provisions of W. Va. Code §
									33-20-7.
4.5. Every rate schedule for non-commercial title
				insurance must be filed with the Commissioner and shall be on file for a waiting
				period of sixty days before it becomes effective. Upon written application by an
				insurer or rating organization, the Commissioner may authorize a filing to become
				effective before the expiration of the waiting period. A filing shall be deemed to
				meet the requirements of article twenty, chapter thirty-three of the West Virginia
				Code unless disapproved by the Commissioner during the waiting period.
4.6. Rate schedules for commercial title insurance
				must be filed with, but need not be approved by, the Commissioner. The Commissioner
				may request additional information to ensure compliance with applicable statutory
				standards, but if the Commissioner does not disapprove the filing within thirty days
				after receipt, the rate filing will become effective upon first usage after filing:
				Provided, That the Commissioner may at any time thereafter, after notice and for
				cause shown, disapprove any rate filing.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-78 - Individual Limited Health Benefits Plans › Section 114-78-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this legislative rule is to establish requirements for information and
				data to be provided with the filing of rates and rate adjustments and forms for
				individual limited health benefit plans, to establish minimum benefits for such
				plans and to define eligibility for individuals to obtain coverage under the
				plans.
1.2. Authority. -- W. Va. Code
				§§
									33-2-10,
				33-15D-2(c) and 33-15D-8.
1.3. Filing
				Date. -- April 6, 2007.
1.4. Effective
				Date. -- April 6, 2007.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-78 - Individual Limited Health Benefits Plans › Section 114-78-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule applies to all individual limited health benefit plans
				  issued pursuant to article fifteen-d, chapter thirty-three of the West Virginia Code
				  and to all insurers offering such plans as of the effective date of this
				  rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-78 - Individual Limited Health Benefits Plans › Section 114-78-3 - Rate Filing

Current through Register Vol. XLI, No. 28, July 12, 2024
All of the provisions of §114 CSR 26, Accident and Sickness
				  Rate Filing, apply to individual limited health benefit plans except §114 CSR
				  26-1.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-78 - Individual Limited Health Benefits Plans › Section 114-78-4 - Form Filing

Current through Register Vol. XLI, No. 28, July 12, 2024
All of the provisions of §14 CSR 67, Rate and Form Filing
				  Abstracts, apply to individual limited health benefits plans.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-78 - Individual Limited Health Benefits Plans › Section 114-78-5 - Eligibility

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. An insurer issuing
				limited health benefit individual health insurance policies shall, as part of the
				application process require the applicant to provide evidence of eligibility in a
				form satisfactory to the Insurance Commissioner and the insurer shall retain the
				evidence of eligibility as long as the policy remains in effect.
5.2. An individual limited health benefits plan
				may only be offered to an adult between the ages of eighteen and sixty-four,
				inclusive, who:
a. Has not had a health benefit
				plan covering him or her for at least the prior twelve consecutive months: Provided,
				That such a plan may not be offered to an employee of an employer that offers a
				health benefits plan to its employees unless that employee does not qualify for
				coverage under such employer plan; or
b.
				Has lost coverage due to a qualifying event. A qualifying event includes loss of
				coverage due to:
(i) emancipation and resultant
				loss of coverage under a parent's or guardian's plan;
(ii) divorce and loss of coverage under the former
				spouse's plan;
(iii) termination of
				employment and resultant loss of coverage under an employer group plan, except for
				loss of employment for gross misconduct; or
(iv) involuntary termination of coverage under a
				group health benefit plan, except for termination due to nonpayment of premiums or
				fraud by the insured.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-78 - Individual Limited Health Benefits Plans › Section 114-78-6 - Benefits

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Every policy issued
				pursuant to this rule must have an annual maximum benefit established by order of
				the Commissioner.
6.2. Every policy
				issued pursuant to this rule must provide benefits for at least the following
				services:
a. Emergency care.
b. Hospital benefits, including physician services
				while in the hospital.
c. Outpatient
				benefits, including lab and diagnostics.
d. Preventive care.
e. Primary care.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-78 - Individual Limited Health Benefits Plans › Section 114-78-7 - Penalties and Enforcement

Current through Register Vol. XLI, No. 28, July 12, 2024
Insurers issuing policies pursuant to this rule are subject to the
				  examination and investigation and enforcement powers of the Insurance Commissioner
				  set forth in article two, chapter thirty-three of the West Virginia Code. Insurers
				  issuing policies under this rule are subject to the provisions of article eleven,
				  chapter thirty-three of the West Virginia Code regulating unfair trade
				  practices.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-79 - Group Limited Health Benefits Plans › Section 114-79-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				establishes guidelines and procedures under which the Commissioner may approve group
				limited health benefit plans.
1.2.
				Authority. -- W. Va. Code §§
									33-2-10,
				33-16F-3
				and
				33-16F-5.
1.3. Filing Date. -- April 6, 2007.
1.4. Effective Date. -- April 6, 2007.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-79 - Group Limited Health Benefits Plans › Section 114-79-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
This rule applies to all group limited health benefit plans issued
				  pursuant to article sixteen-f, chapter thirty-three of the West Virginia Code and to
				  all insurers offering such plans as of the effective date of this rule. This rule
				  does not apply to policies defined as an "excepted benefit" in W. Va. Code §
									33-16-1
				  a(2).
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-79 - Group Limited Health Benefits Plans › Section 114-79-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. "Commissioner"
				means the West Virginia Insurance Commissioner.
3.2. "Group limited health benefits plan" means a
				plan as defined in W. Va. Code §
									33-16F-2.
3.3. "Part-time employee" is an employee who is
				employed to work fewer hours each week than a full time employee at the employer's
				business. An insurer may set minimum number of hours a part time employee may work
				to be eligible for its group limited health benefits plan.
3.4. "Seasonal employee" is an employee who is
				employed to work less than the full calendar year at an employment activity that is
				determined by seasonal or calendar changes.
3.5. "Temporary employee" is an employee whose
				term of employment has a defined time of termination.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-79 - Group Limited Health Benefits Plans › Section 114-79-4 - Rate Filing

Current through Register Vol. XLI, No. 28, July 12, 2024
All of the provisions of §114 CSR 26, Accident and Sickness
				  Rate Filing, apply to group limited health benefits plans except §114 CSR
				  26-1.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-79 - Group Limited Health Benefits Plans › Section 114-79-5 - Form Filing

Current through Register Vol. XLI, No. 28, July 12, 2024
All of the provisions of 114 CSR 67, Rate and Form Filing
				  Abstracts, apply to group limited health benefit plans.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-79 - Group Limited Health Benefits Plans › Section 114-79-6 - Eligibility

Current through Register Vol. XLI, No. 28, July 12, 2024
A group limited health benefits plan may cover only a class of
				  employees made up of part-time, temporary or seasonal employees that (i) are
				  ineligible for coverage under any of the employer's group health benefits plans, or
				  (ii) are employed by an employer that does not offer a group health benefits plan to
				  any of its employees.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-79 - Group Limited Health Benefits Plans › Section 114-79-7 - Benefits

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Every policy issued
				pursuant to this rule must have an annual maximum benefit established by order of
				the Commissioner.
7.2. Every policy
				issued pursuant to this rule must provide benefits for at least the following
				services:
a. Emergency care.
b. Hospital benefits, including physician services
				while in the hospital.
c. Outpatient
				benefits, including lab and diagnostics.
d. Preventive care benefits.
e. Primary care benefits.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to implement W. Va. Code §33-13C relating to the
				regulation of persons and institutions engaged in the business of viatical
				settlements in West Virginia and to protect the public from unfair and
				unconscionable practices in the course of that business. This rule is based on the
				National Association of Insurance Commissioners' "Viatical Settlement Regulation"
				(Model 698), as amended in 2004.
1.2.
				Authority. -- W. Va. Code §§
									33-2-10,
				33-13C-3(b),
				33-13C-5(b),
				33-13C-12(d)
				and
				33-13C-17.
1.3. Filing Date. -- April 14, 2010.
1.4. Effective Date. -- April 14, 2010.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
In addition to the definitions in W.Va. Code §
									33-13C-2, the following
				  definitions apply:
2.1. "Escrow agent"
				means an independent third-party person who, pursuant to a written agreement signed
				by the viatical settlement provider, viatical settlement broker and viator, provides
				escrow services related to the acquisition of a life insurance policy pursuant to a
				viatical settlement contract. "Escrow agent" does not include any person associated
				with, affiliated with, or under the control of a person licensed under W.Va. Code
				§
									33-13C-3
				or any person retained to represent a viator who is licensed as an attorney,
				certified public accountant or financial planner accredited by a nationally
				recognized accreditation agency whose compensation is not paid directly or
				indirectly by the viatical settlement provider, and whose viatical settlement
				activities are incidental to the professional practice of the attorney, certified
				public accountant or financial planner. "Escrow agent" also does not include an
				insurance producer authorized to act under W. Va. Code §33-13C-
				3(2)(A).
2.2. "Insured" means the person
				covered under the policy being considered for viatication.
2.3. "Life expectancy " means the arithmetic mean
				of the number of months the individual insured under the life insurance policy to be
				viaticated can be expected to live as determined by an independent life expectancy
				provider considering medical records and appropriate experiential data..
2.4. "Net death benefit" means the amount of the
				life insurance policy or certificate to be viaticated less any outstanding debts or
				liens.
2.5. "Patient identifying
				information" means an insured's address, telephone number, facsimile number,
				electronic mail address, photograph or likeness, employer, employment status, social
				security number, or any other information that is likely to lead to the
				identification of the insured.
2.6.
				"Brochure" means an informational brochure that is distributed to viators explaining
				viatical settlement contracts. The brochure shall be in the National Association of
				Insurance Commissioners' (NAIC) format unless the Commissioner develops or adopts
				another version and makes it available on the Insurance Commission's website:
				Provided, That a licensed provider may apply to the Commissioner for permission to
				use a specific brochure in lieu of the NAIC brochure or other one approved by the
				Commissioner.
2.7. "Proposal" means the
				documents distributed to a viator by a viatical settlement provider pursuant to
				section 10 of this rule that outlines the terms and conditions of the viatical
				settlement contract.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-3 - Viatical Settlement Provider Licensing and Renewal Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. A person shall not
				operate as a viatical settlement provider without first obtaining a license from the
				Commissioner pursuant to W. Va. Code §
									33-13C-3
				and this rule.
3.2. A person must submit
				the following to obtain a license to act as a viatical settlement provider in this
				state:
3.2.a. A fully completed Viatical
				Settlement Provider Application (VSP-2);
3.2.b. A $600.00 non-refundable application
				fee;
3.2.c. A certificate of good
				standing from state of domicile;
3.2.d.
				A West Virginia business license;
3.2.e.
				A copy of the last certified public accountant audit and if any, the latest
				financial and market conduct examination reports from the state of
				domicile;
3.2.f. An unaudited financial
				statement for the most recent quarter;
3.2.g. Evidence of a minimum equity of not less
				than $250,000 in cash or cash equivalents reflected in the applicant's audited
				financial statements or through a surety bond executed and issued by an insurer
				authorized to issue bond in this state in the amount of $250,000;
3.2.h. A detailed plan of operations;
3.2.i. An anti-fraud plan that meets the
				requirements of W. Va. Code §
										33-13C-14;
3.2.j. National Association of Insurance
				Commissioners' UCAA biographical affidavit for each individual, member, officer or
				principal owner (ownership of ten percent or more of the company) of applicant and
				each person to be authorized to act under the license;
3.2.k. If the applicant is a member of a holding
				company system, submit an organizational chart which depicts the affiliate
				relationships among the members. "Affiliate" means a person that directly or
				indirectly through one or more intermediaries is controlled by or is under common
				control with the member specified. "Control" shall be presumed to exist if any
				person directly or indirectly owns, controls, holds with the power to vote or holds
				proxies representing collectively ten percent or more of the voting securities of
				any other person;
3.2.l. Samples of all
				forms the provider uses or plans to use to enter into viatical settlement contracts
				with viators and viator application forms;
3.2.m. Samples of all advertising and other
				solicitation materials the provider plans to use in the state; and
3.2.n. Samples of all informational
				brochures.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-4 - Viatical Settlement Broker Licensing and Renewal Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. A person or entity
				shall not operate as a viatical settlement broker without first obtaining a license
				from the Commissioner pursuant to W. Va. Code §
									33-13C-3
				and this rule.
4.2. A person or entity
				must submit the following to obtain a license to act as a viatical settlement broker
				in this state:
4.2.a. A fully completed Viatical
				Settlement Broker Application (VSB-2);
4.2.b. If a legal entity, a certificate of good
				standing from state of domicile;
4.2.c.
				Evidence of a minimum equity of not less than $250,000 in cash or cash equivalents
				reflected in the applicant's audited financial statements or through a surety bond
				executed and issued by an insurer authorized to issue bond in this state in the
				amount of $250,000: Provided, That the Commissioner may permit an applicant for a
				broker's license to demonstrate evidence of financial responsibility through a
				policy of insurance covering legal liability resulting from erroneous acts or
				failure to act in their capacity as a viatical settlement broker and inuring to the
				benefit of any aggrieved party as the result of any single occurrence in the sum of
				not less than $100,000 and $300,000 in the aggregate for all occurrences within one
				year;
4.2.d. An anti-fraud plan that
				meets the requirements of W. Va. Code §
										33-13C-14(g);
4.2.e. If a legal entity, National Association of
				Insurance Commissioners' UCAA biographical affidavit for each individual, member,
				officer or principal owner (ownership of ten percent or more of the company) of
				applicant;
4.2.f. Samples of
				informational brochures to be provided to prospective viators describing the
				viatical settlement process.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-80 - Viatical Settlements › Section 114-80-5 - Standards for Evaluation of Reasonable Payments for Terminally or Chronically Ill Insureds

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. In order to
				assure that viators who are terminally or chronically ill receive a reasonable
				return for viaticating an insurance policy, the return for viaticating a policy
				shall be no less than the following payout:
5.1.a.
				If the life expectancy is less than six months, eighty percent of the net death
				benefit.
5.1.b. If the life expectancy
				is at least six months but less than twelve months, seventy percent of the net death
				benefit.
5.1.c. If the life expectancy
				is at least twelve months but less than eighteen months, sixty-five percent of the
				net death benefit.
5.1.d. If the life
				expectancy is at least eighteen months but less than twenty-five months, sixty
				percent of the net death benefit.
5.1.e.
				If the life expectancy is twenty-five months or more, the viator must receive at
				least the greater of the cash surrender value or accelerated death benefit in the
				policy.