reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-6 - Reasonableness of Benefits in Relation to Premium Charge

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. An insurer may revise its schedule of premium
				rates from time to time and shall file the revised schedules with the Commissioner
				pursuant to the filing requirements in section five of this rule. An insurer shall
				not issue a credit personal property insurance policy for which the premium rates
				exceed that determined by the approved schedules of the insurer then on file with
				the Commissioner.
6.2. Benefits provided
				by credit personal property insurance policies shall be reasonable in relation to
				the premium charged. This requirement is satisfied if the premium rate charged
				develops or may reasonably be expected to develop a loss ratio of not less than
				sixty percent or such other loss ratio as designated by the Commissioner to afford a
				reasonable allowance for actual and expected loss experience including a reasonable
				catastrophe provision, general and administrative expenses, reasonable acquisition
				expenses, reasonable creditor compensation, investment income, premium taxes,
				licenses, fees, assessments, and reasonable insurer profit.
6.3. For open-end credit transactions, an
				insurer's rating plan shall address, by grouping of like accounts, the expected
				variance in the mix of goods purchased that are covered under the credit personal
				property coverage versus items purchased that are not covered under the credit
				personal property coverage. Accounts shall be separated into groupings that possess
				or are expected to possess a similar mix of covered goods purchased versus not
				covered goods purchased.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-7 - Experience Reports and Triennial Filing Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. An insurer doing insurance business in this
				state shall annually file with the Commissioner and the National Association of
				Insurance Commissioners (NAIC) a report of credit personal property insurance
				written on a calendar year basis. The report shall utilize the Credit Insurance
				Supplement-Annual Statement Blank approved by the NAIC, and shall contain data
				separately for each state, rather than an allocation of the company's countrywide
				experience. The filing shall be made in accordance with and no later than the due
				date in the Instructions to the Annual Statement.
7.2. Rates that have been filed and approved
				pursuant to section 5 of this rule are effective for a period not to exceed three
				(3) years. An insurer shall file a new rate or support the previously approved rate
				before the three-year period expires. An insurer may file for a new rate before the
				end of the three-year period.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-8 - Cancellation and Refund of Unearned Premium

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Upon cancellation for any reason, the debtor
				is entitled to a refund of unearned premiums calculated on a daily pro rata basis.
				No refunds of less than one dollar are required.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-61 - Credit Personal Property › Section 114-61-9 - Claims

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. All claims shall be
				promptly reported by the creditor to the insurer or its designated claim
				representative, and the insurer shall maintain adequate claim files. All claims
				shall be settled as soon as possible and in accordance with the terms of the
				insurance contract.
9.2. All claims
				shall be paid either by draft drawn upon the insurer, by electronic funds transfer,
				or by check of the insurer to the order of the claimant to whom payment of the claim
				is due pursuant to the policy provisions, or upon direction of the claimant to the
				party specified by the claimant.
9.3. No
				plan or arrangement may be used whereby any person, firm or corporation other than
				the insurer or its designated claim representative is authorized to settle or adjust
				claims. The creditor may not be designated as claim representative for the insurer
				in adjusting claims:
Provided
, that once the amount is determined a
				group policyholder may, by arrangement with the group insurer, draw drafts, checks
				or electronic transfers in payment of claims due to the group policyholder subject
				to audit and review by the insurer.
9.4.
				No claim may be denied because the debtor was ineligible for coverage later than
				ninety days after the initiation of coverage unless the debtor misrepresented a
				material fact. If a claim is denied because the debtor was ineligible for coverage
				within ninety days after initiation of coverage or because the debtor misrepresented
				a material fact for coverage, the insurer shall refund to the debtor all premium
				paid and the creditor shall refund any finance charge paid on the premium.
9.5. All claims for credit personal property
				insurance shall be subject to W. Va. Code §
									33-11-4(9).
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-62 - Standards For Safeguarding Consumer Information › Section 114-62-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				establishes standards for developing and implementing administrative, technical and
				physical safeguards to protect the security, confidentiality and integrity of
				customer information, pursuant to sections 501 and 507, and subsection 505(b) of the
				Gramm-Leach-Bliley Act, codified at
				15 U.S.C.
				6801,
				6807 and
				6805(b).
				Section 507 of the Act provides, among other things, that a state regulation may
				afford persons greater privacy protections than those provided by subtitle A of
				Title V of the Gramm-Leach-Bliley Act. The safeguards established pursuant to this
				rule shall apply to nonpublic personal information, including nonpublic personal
				financial information and nonpublic personal health information.
1.2. Authority. -- W.Va. Code §§
									33-6F-1 and
				33-2-10.
a. Subsection 501(a) of the Gramm-Leach-Bliley
				Act,
				15 U.S.C.
				6801, provides that it is the policy of the
				Congress that each financial institution has an affirmative and continuing
				obligation to respect the privacy of its customers and to protect the security and
				confidentiality of those customers' nonpublic personal information.
b. Subsection 501(b) of the Act requires the state
				insurance regulatory authorities to establish appropriate standards relating to
				administrative, technical and physical safeguards:
1. To ensure the security and confidentiality of
				customer records and information;
2. To
				protect against any anticipated threats or hazards to the security or integrity of
				such records; and
3. To protect against
				unauthorized access to or use of records or information that could result in
				substantial harm or inconvenience to a customer.
c. Paragraph 505(b)(2) of the Gramm-Leach-Bliley
				Act, 15
				U.S.C. 6805(b), calls on state
				insurance regulatory authorities to implement the standards prescribed under
				subsection 501(b) by regulation with respect to persons engaged in providing
				insurance.
d. Paragraph 503(a)(3) of the
				Gramm-Leach-Bliley Act, codified at 15 U.S.C. section 6803 (a)(3), requires each
				financial institution to develop policies for protecting the nonpublic personal
				information of consumers and to make those policies available in written
				form.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-62 - Standards For Safeguarding Consumer Information › Section 114-62-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Customer" means a
				customer of the licensee as the term is defined in subsection 2.9 of the insurance
				commissioner's rule on privacy of consumer financial and health information,
				114CSR57.
2.2. "Customer information"
				means any nonpublic personal information as defined in subsection 2.19 of the
				insurance commissioner's rule on privacy of consumer financial and health
				information, 114CSR57, about a customer, whether in paper, electronic or other form,
				that is maintained by or on behalf of the licensee. For purposes of this rule,
				customer information shall also include information submitted to a licensee by a
				consumer on an application for an insurance product, regardless of whether the
				insurance product is ultimately purchased by the consumer.
2.3. "Customer information systems" means the
				electronic or physical methods used to access, collect, store, use, transmit,
				protect or dispose of customer information.
2.4. "Licensee" means a licensee as that term is
				defined in subsection 2.17 of the insurance commissioner's rule on privacy of
				consumer financial and health information, 114CSR57, except that "licensee" shall
				not include:
a. A purchasing group; or
b. An unauthorized insurer in regard to the excess
				line business conducted pursuant to article twelve-c, chapter thirty-three of the
				West Virginia Code.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-62 - Standards For Safeguarding Consumer Information › Section 114-62-3 - Information Security Program

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Each
				licensee shall implement a comprehensive written information security program that
				includes administrative, technical and physical safeguards for the protection of
				customer information. The administrative, technical and physical safeguards included
				in the information security program shall be appropriate to the size and complexity
				of the licensee and the nature and scope of its activities.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-62 - Standards For Safeguarding Consumer Information › Section 114-62-4 - Objectives of Information Security Program

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. A licensee's information security program
				shall be designed to:
a. Ensure the security and
				confidentiality of customer information;
b. Protect against any anticipated threats or
				hazards to the security or integrity of the information; and
c. Protect against unauthorized access to or use
				of the information that could result in substantial harm or inconvenience to any
				customer.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-62 - Standards For Safeguarding Consumer Information › Section 114-62-5 - Methods of Development and Implementation

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The actions and procedures set forth in this
				section are nonexclusive examples of methods a licensee may use to implement the
				requirements of sections three and four of this rule.
5.2. The licensee assesses risk by:
a. Identifying reasonably foreseeable internal or
				external threats that could result in unauthorized disclosure, misuse, alteration or
				destruction of customer information or customer information systems;
b. Assessing the likelihood and potential damage
				of these threats, taking into consideration the sensitivity of customer information;
				and
c. Assessing the sufficiency of
				policies, procedures, customer information systems and other safeguards in place to
				control risks.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-62 - Standards For Safeguarding Consumer Information › Section 114-62-6 - Violation

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1 Violations of this
				rule are subject to the provisions of W. Va. Code §§
									33-3-11
				and
				33-12-24.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-63 - Standard Motor Vehicle Policy Provisions › Section 114-63-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				establishes the standard motor vehicle insurance policy provisions as required by W.
				Va. Code §
									33-6-31(i).
1.2. Authority. -- W. Va. Code §§
									33-6-31(i)
				and
				33-2-10.
1.3. Filing Date. -- April 3, 2003.
1.4. Effective Date. -- April 3, 2003.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-63 - Standard Motor Vehicle Policy Provisions › Section 114-63-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Motor Vehicle"
				means a car, auto, or other synonym as such word is defined in the policy.
2.2. "Underinsured Motor Vehicle" means a motor
				vehicle with respect to the ownership, operation or use of which there is liability
				insurance applicable at the time of the accident but the limits actually available
				to the injured person in question are less than the total amount of damages
				sustained by the injured person regardless of the comparison between such liability
				insurance limits actually available and the underinsured motorist coverage
				limits.
2.3. "Uninsured Motor Vehicle"
				means a motor vehicle as to which there is no:
a.
				Bodily injury liability insurance and property damage liability insurance, or
b. There is such insurance, but the
				insurance company writing the same denies coverage thereunder; and
c. There is no certificate of self
				insurance.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-63 - Standard Motor Vehicle Policy Provisions › Section 114-63-4 - Uninsured Motor Vehicle Insurance Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. All motor vehicle policies shall contain a
				provision undertaking to pay the insured all sums which he or she shall be legally
				entitled to recover as damages from the owner or operator of an uninsured motor
				vehicle up to the limit selected by the named insured on a properly completed form
				pursuant to W. Va. Code §
									33-6-31d.
4.2. Uninsured motor vehicle coverage shall not
				contain family member exclusions.
4.3.
				Uninsured motor vehicle coverage shall not contain a provision requiring
				arbitration. W. Va. Code §
									33-6-31(g).
4.4. Uninsured motor vehicle coverage may contain
				a provision excluding the first three hundred dollars of property damage but shall
				not contain any other deductible or setoff up to the limits of the uninsured
				motorist coverage. W. Va. Code §
									33-6-31(b).
4.5. Uninsured motor vehicle coverage may contain
				a provision requiring that the insured use reasonable diligence, upon learning that
				the tortfeasor is uninsured, to provide notice of any potential uninsured motor
				vehicle claim within a reasonable period of time.
4.6. Uninsured motor vehicle coverage may contain
				an "owned but not insured exclusion" precluding benefits above the minimum financial
				responsibility limits contained in W. Va. Code §
									17D-4-2.
4.7. Uninsured motor vehicle coverage may contain
				a provision excluding benefits for injuries which result from a motor vehicle
				collision which occurs within the course and scope of employment but only with
				respect to fault of the employer or co-employee and not with regard to the fault of
				a third party.
4.8. With regard to
				uninsured motor vehicle coverage in the event of negligence by an unknown
				tortfeasor, the policy may contain a provision requiring a close and substantial
				physical nexus between the unidentified hit and run vehicle and the insured vehicle.
				"Close and Substantial Physical Nexus" means evidence which can be established by
				independent third-party testimony to the satisfaction of the trial judge and the
				jury that, but for the immediate evasive action of the insured, direct physical
				contact would have incurred between the unknown motor vehicle and the
				victim.
4.9. Uninsured motor vehicle
				coverage may contain a provision providing for the right of subrogation against the
				tortfeasor up to the amount paid under the uninsured motor vehicle endorsement,
				consistent with W. Va. Code §
									33-6-31(f).
4.10. Uninsured motor vehicle coverage
				may include an exclusion for punitive damage liability.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-63 - Standard Motor Vehicle Policy Provisions › Section 114-63-6 - Replacement of Earlier Provisions and Future Compliance

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. This rule shall completely replace
				Informational Letters two, revised, and two-a, and all contrary policy provisions
				approved by the Insurance Commission before the effective date of this rule.
				Thereafter all policy provisions must be in compliance with this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. - The
				purpose of this rule is to establish the requirements, process, and forms to be
				utilized by insurers and carriers to ensure the parity of benefits for behavioral
				health, mental health and substance use disorders with medical/surgical benefits and
				to ensure carrier compliance with W.Va. Code §§
									33-15-4u,
				33-16-3f
				f,
				33-24-7u,
				33-25-8r,
				and
				33-25A-8u.
				This rule applies to all health insurance policies, contracts, plans or agreements
				subject to Articles 15, 16, 24, 25, or 25A of Chapter 33 of the West Virginia Code
				that are delivered, executed, issued amended, adjusted, or renewed in this state on
				or after January 1, 2021.
1.2.
				Authority. - W. Va. Code §§
									33-2-10,
				33-15-4u,
				33-16-3f
				f,
				33-24-7u,
				33-25-8r,
				and
				33-25A-8u.
1.3. Filing Date. - April 14,
				2021.
1.4. Effective Date. - May 1,
				2021.
1.5. Sunset Date. - This rule
				shall terminate and have no further force or effect upon August 1, 2026.
1.6. This legislative rule repeals and replaces
				114CSR64 "Mental Health Parity" filed on April 14, 2010 and effective April 14,
				2010.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-4 - Financial Requirements and Quantitative Treatment Limitations

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. An insurer or
				carrier shall comply with financial requirements and quantitative treatment
				limitations specified in
				45 CFR
				§
										146.136(c)(2) and (c)(3),
				or any successor federal regulation as adopted by the Legislature through subsequent
				amendment to this rule.
4.2. An insurer
				or carrier shall not impose any financial requirement or quantitative treatment
				limitation on behavioral, mental health, or substance use disorder benefits that it
				does not impose on medical/surgical benefits.
4.3. An insurer or carrier shall not impose annual
				maximums on the number of visits or dollar amounts for behavioral, mental health, or
				substance use disorder benefits.
4.4. An
				insurer or carrier shall not impose any financial requirement or quantitative
				treatment limitation on behavioral, mental health, or substance use disorder
				benefits, unless the financial requirement or quantitative treatment limitation
				applies to substantially all of the medical/surgical benefits in a permitted benefit
				classification.
4.4.1. Benefit classifications may
				include:
4.4.1.a. Inpatient in-network;
4.4.1.b. Inpatient out-of-network;
4.4.1.c. Outpatient in-network, except that
				insurers or carriers may use the following sub-classifications;
4.4.1.c.1. Office visits, such as physician
				visits; and
4.4.1.c.2. All other
				outpatient services, such as outpatient surgery, day treatment centers, laboratory
				charges, or other medical items;
4.4.1.d. Outpatient out-of-network, except that
				insurers or carriers may use the following sub-classifications;
4.4.1.d.1. Office visits, such as physician
				visits; and
4.4.1.d.2. All other
				outpatient services, such as outpatient surgery, day treatment centers, laboratory
				charges, or other medical items;
4.4.1.e. Emergency; and
4.4.1.f. Pharmacy.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-5 - Non-Quantitative Treatment Limitations

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				An insurer or carrier shall comply with the non-quantitative treatment limitation
				requirements specified in
				45 CFR
				§
										146.136(c)(4), or any
				successor regulation as adopted by the Legislature through subsequent amendment to
				this rule, regarding any limitations that are not expressed numerically but
				otherwise limit the scope or duration of benefits for treatment, which in addition
				to the limitations and examples listed in
				45 CFR
				§
										146.136(c)(4)(ii) and
				(c)(4)(iii), or any successor regulation, as
				adopted by the Legislature through subsequent amendment to this rule, and 78 FR
				68246, include the methods by which the carrier establishes and maintains its
				provider network and responds to deficiencies in the ability of its networks to
				provide timely access to care.
5.2. An
				insurer or carrier shall not apply any non-quantitative treatment limitation to
				benefits for behavioral health, mental health, and substance use disorders that are
				not applied to medical/surgical benefits within the same classifications of
				benefits. Specifically, an insurer or carrier shall not impose a non-quantitative
				treatment limitation with respect to behavioral, mental health, and substance use
				disorder services in any classification unless, under the terms of the coverage as
				written and in operation, any processes, strategies, evidentiary standards, or other
				factors used in applying the non-quantitative treatment limitation to behavioral,
				mental health, or substance use disorder services are comparable to, and are applied
				no more stringently than, the processes strategies, evidentiary standards, or other
				factors used in applying the limitation with respect to medical/surgical benefits in
				the classification.
5.3.
				Non-quantitative treatment limitations include, but are not limited to:
5.3.1. Medical management standards limiting or
				excluding benefits based on:
5.3.1.a. Medical
				necessity or medical appropriateness; or
5.3.1.b. Whether the treatment is experimental or
				investigational.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-6 - Concurrent Review and Denial of Benefits

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				In the event of a concurrent review for a claim for coverage of services for the
				prevention of, screening for, and treatment of behavioral health, mental health, and
				substance use disorders, the insurer or carrier must continue to cover the service
				until the insurer or carrier notifies the covered person of the determination of the
				claim.
6.2. An insurer or carrier shall
				provide the covered person with written notice of a denial when denying benefits for
				the treatment of behavioral health, mental health, and/or substance use disorders
				that explicitly provides the reason for the denial.
6.3. Unless denied for nonpayment of premium, a
				denial of reimbursement for services for the prevention of, screening for, or
				treatment of behavioral health, mental health, and/or substance use disorders by the
				insurer or carrier must include the following language:
6.3.1. A statement explaining that covered persons
				are protected under state and federal law, which provides that limitations placed on
				the access to behavioral health, mental health, and/or substance use disorder
				benefits may be no greater than any limitations placed on access to medical/surgical
				benefits for physical illness or injury;
6.3.2. A statement providing that the covered
				person may contact the Consumer Services Division of the West Virginia Offices of
				the Insurance Commissioner if the covered person believes his or her rights under
				state or federal law have been violated. The statement should provide up-to-date
				contact information for the Consumer Services Division, including the current
				mailing address, toll-free telephone number, email address and website;
				and
6.3.3. A statement specifying that
				the covered person is entitled, upon request to the insurer or carrier, to a copy of
				the medical necessity criteria for any behavioral health, mental health, and
				substance use disorder benefit.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-7 - Annual Reporting to the Commissioner

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. As part
				of their annual health benefit plan filings, insurers or carriers shall provide an
				attestation to the commissioner that:
7.1.1. The
				plan applies the same deductible for medical/surgical and behavioral, mental health,
				and substance use disorders and does not otherwise apply any cumulative financial
				requirement for behavioral health, mental health, and substance use disorders in a
				classification that accumulates separately from any established for medical/surgical
				benefits in the same classification;
7.1.2. The plan applies the same out-of-pocket for
				medical/surgical and behavioral, mental health, and substance use disorders and does
				not otherwise apply any cumulative financial requirement for behavioral health,
				mental health, and substance use disorders in a classification that accumulates
				separately from any established for medical/surgical benefits in the same
				classification;
7.1.3. The plan uses the
				same benefits for emergency room benefits, including all ancillary services provided
				as part of the emergency room benefits, for medical/surgical and behavioral, mental
				health, and substance use disorders;
7.1.4. The plan utilizes the same copayment,
				coinsurance or deductible structure for prescription drug benefits for
				medical/surgical and behavioral, mental health, and substance use
				disorders;
7.1.5. The carrier utilizes
				the same penalties for failure to obtain prior authorization for behavioral, mental
				health, and substance use disorders as it does for medical/surgical procedures
				within the same classification of benefits.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-9 - Confidentiality

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. The information and
				data obtained by the commissioner from an insurer or carrier under this rule shall
				be considered proprietary and confidential by law and privileged, exempt from
				disclosure pursuant to Chapter 29B of the West Virginia Code, confidential pursuant
				to W.Va. Code §§
									33-2-9
				and
				33-2-19,
				and is not open to public inspection, subject to subpoena, subject to discovery or
				admissible in evidence in any criminal, private civil or administrative action and
				is not subject to production pursuant to court order. However, the commissioner is
				authorized to use the documents, materials or other information in the furtherance
				of any investigation, regulatory action or legal action brought as part of the
				commissioner's official duties and to share information with other state or federal
				regulatory authorities as set forth in W.Va. Code §
									33-2-19.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-64 - Mental Health Parity › Section 114-64-10 - Enforcement

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. Noncompliance with
				this rule may result, after proper notice and hearing, in the imposition of any of
				the sanctions made available to the Commissioner, including but not limited to, the
				imposition of monetary penalties, issuance of cease and desist orders, and/or
				suspensions or revocations of licenses or certificates of authority. Among others,
				the penalties provided for in W.Va. Code §§
									33-2-11
				and
				33-3-11
				may be applied.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This rule
				sets forth the procedural requirements for the creation and regulatory oversight of
				self-insurance pools created to insure workers' compensation and civil liability
				risks of political subdivisions.
1.2.
				Authority. -- This rule is promulgated pursuant to the authority granted by W.Va.
				Code §§
									29-12A-16(g)
				and
				33-2-10.
1.3. Filing Date. -- April 19, 2011.
1.4. Effective Date. -- April 19, 2011.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-3 - Establishment of Pools Authorized

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1.
				Regardless of whether a political subdivision secures a policy or policies of
				workers' compensation insurance or civil liability insurance, establishes and
				maintains a self-insurance program, or enters into an agreement for the joint
				administration of a self-insurance program, the political subdivision may, subject
				to approval by the Commissioner and pursuant to a written agreement and to the
				extent that it considers necessary, join with one or more political subdivisions to
				purchase group insurance or to establish and maintain a pool to provide coverage for
				its workers' compensation, civil liability risks, or both.
3.2. Two or more political subdivisions may
				establish and maintain a joint risk-management program, including but not limited to
				the employment of a risk manager or managers and consultants, for the purpose of
				preventing and reducing the risks covered by insurance, self-insurance, or a
				pool.
3.3. A pool is not an insurance
				company, its operation does not constitute the transaction of insurance, and it is
				not subject to the insurance laws of this State unless otherwise specifically stated
				herein.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-4 - Criteria for Establishing and Maintaining Self-Insurance Pools

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Before a pool may begin to offer civil
				liability coverage to members, the following must be filed with the Commissioner:
4.1.a. A copy of a financial plan which must set
				forth:
4.1.a.1. The insurance coverages to be
				offered by the pool, applicable deductible levels, and the maximum level of claims
				to be self-insured against;
4.1.a.2. The
				pool's proposed rates, which should not be excessive, inadequate or unfairly
				discriminatory taking into account all underwriting, exposure and claims history
				when pricing any current or prospective pool members. A pool's rates are not subject
				to prior approval by the Commissioner , however appropriate regulatory action may be
				taken if he or she determines that the rates are not in compliance with this
				rule;
4.1.a.3. The amount of cash
				reserves as are necessary, in the exercise of sound and prudent actuarial judgment,
				to cover potential pool members and employee liability, expense, loss, and damage,
				which cash reserves may be funded by the issuance of certificates of participation
				by the pool and its members and reinsurance; and
4.1.a.4. The amount of aggregate excess insurance
				or reinsurance coverage to be purchased in the event that the pool's resources are
				exhausted in a given fiscal period;
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-6 - Investments

Current through Register Vol. XLI, No. 28, July 12, 2024
The board may invest funds in any type of investments authorized
				  by W.Va. Code §
									33-8-1
et
				  seq.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-8 - Additional Requirements for Workers' Compensation Pools

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. To the extent not inconsistent with this
				rule, each workers' compensation pool is subject to the requirements of
West
				Virginia Code
§§ 33-2-21 and 33-2-22 and
West Virginia
				Code
Chapter Twenty-Three and the rules promulgated thereunder, including
				but not limited to the payment of surcharges pursuant to
West Virginia
				Code
§§ 23-2C-3(f)(2) and 23-2C-3(f)(3)(B) and
West
				Virginia Code
St. R. Section
				85-6-1
et
				seq.;
the record retention requirements of
West Virginia
				Code
St. R. Section
				85-18-13;
				and the data requirements of
West Virginia Code
St. R. Section
				85-2-1
et. seq.:
				Provided,
That such a pool is subject to
West Virginia
				Code
St. R. Section
				85-18-1
et
				seq.;
as if the pool was a single self-insured employer:
Provided,
however, That no provision of Chapter Twenty-Three of
				this code or any rule promulgated thereunder requiring participation in the
				self-insured guarantee risk pool and the self-insured security risk pool, or
				providing for industrial council approval of self-insured status, termination of
				self-insured status or approval of security, shall apply.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-9 - Filing of Reports; Examination by Commissioner

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. Every pool authorized by the Commissioner
				must file with the Commissioner and distribute to pool members within 180 days
				following the pool's fiscal year end an audited statement of its financial condition
				and business for the most recently completed fiscal year; such statement must be
				signed on behalf of the pool by two duly authorized officers or a duly authorized
				officer and the administrator.
9.2. The
				financial statement must be audited by an independent certified public accountant
				and verified by the signature and oath of the pool's authorized representative. If a
				pool fails to file the audited financial statement required by this section, the
				Commissioner may have the audit performed. If the audit is performed by the
				Commissioner's staff, it will be at the expense of the pool and all working papers
				will be confidential and not open for public inspection until the audit is
				final.
9.3. The audited financial
				statement shall contain a report in detail of the pool's assets, outstanding
				liabilities, including the amount of claims paid to date and current reserves for
				losses, revenues and disbursements during the year, the investments of the pool's
				assets and all other information that the Commissioner deems necessary to secure a
				full and accurate knowledge of the financial affairs and condition of the pool. The
				working papers of the certified public accountant and other records pertaining to
				the preparation of the audited financial statements may be reviewed by the
				Commissioner.
9.4. In addition to the
				annual audited financial statement, the Commissioner may require any pool to file
				additional financial information, including interim financial reports and additional
				reports, exhibits or statements considered necessary to secure complete information
				concerning the condition, solvency, experience, transactions or affairs of the pool.
				The Commissioner shall establish reasonable deadlines for filing these additional
				reports, exhibits or statements and may require verification as the Commissioner
				shall designate.
9.5. The pool must
				retain and have available for examination by the Commissioner all executed copies of
				the application of each political subdivision for membership in the pool and a
				certified copy of each political subdivision's resolution authorizing membership in
				the pool.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-10 - Reserves

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. Every pool shall
				calculate the amount reasonably determined to be sufficient to provide for the
				payment of every loss or claim whether reported or unreported and whether arising on
				or prior to the date of any annual or other statement, and it shall maintain a
				reserve liability in an amount estimated in the aggregate to provide for the payment
				of all such losses or claims and any expenses related thereto.
10.2. Each pool shall maintain reserves equal to
				the unearned portion of the gross contribution or assessment, if any, on unexpired
				or unterminated risks.
10.3. Reserves
				for coverages based on life expectancy shall be computed according to tables of
				mortality and rates of interest prescribed in Section 415 of the Internal Revenue
				Code.
10.4. Every pool may receive
				credit for insurance or reinsurance recoverable from an insurance company licensed
				to transact such insurance in West Virginia or any state of the United States or the
				District of Columbia and meeting the standards of solvency at least equal to those
				required in West Virginia. A pool may receive credit for insurance or reinsurance
				with any other insurer to the extent that funds are withheld as security for the
				payment of obligations thereunder if such funds are held subject to withdrawal by
				and are under the control of the pool. Such funds may include letters of credit
				subject to the approval of the Commissioner. Credit may be received for insurance or
				reinsurance recoverable on the basis of an agreement entered into with individual
				unincorporated underwriters having a trusteed surplus of at least
				$100,000,000.
10.5. Credit may be
				received for insurance or reinsurance when the contract is:
10.5.a. Not cancellable or terminable for any
				reason except upon not less than 60 days written notice sent by registered or
				certified mail to (i) the pool and (ii) the Commissioner;
10.5.b. Automatically renewable at the expiration
				of the policy period except upon 60 days written notice sent by registered or
				certified mail to (i) the pool, and (ii) the Commissioner.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-11 - Additional Contribution Requirements for Workers' Compensation Pools

Current through Register Vol. XLI, No. 28, July 12, 2024
11.1. For the purpose of
				funding a workers' compensation pool, the members shall make contributions to the
				pool based on annual payrolls for all employees of each member using rates as
				adopted by the board and approved by the Commissioner. The rates to be used are
				those in effect as of the inception of each pool's fiscal year. A plan that allows
				for consideration of past experience in developing a factor to be applied to a
				member's contribution may be used provided this plan has been approved by the
				Commissioner.
11.2. Each workers'
				compensation pool shall file with the Commissioner the basis for establishing the
				annual contributions of its members; such contributions must be based on reasonable
				assumptions and certified by an actuary or other person satisfactory to the
				Commissioner as to the sufficiency of such contributions.
11.3. The total amount of each member's annual
				contribution to the workers' compensation pool shall be certified by the board to
				the governing body of each member at least one month prior to the beginning of the
				next fiscal year, if practical.
11.4.
				Each workers' compensation pool may impose upon its members and former members an
				additional assessment whenever needed to supplement the pool's surplus to assure
				payment of its obligations.
11.4.a. The workers'
				compensation pool may assess each participating member an additional proportionate
				amount, as provided in the pool's member agreement or as provided in the pool's plan
				filed with the Commissioner to correct a deficit condition.
11.4.b. The board shall submit to the Commissioner
				a report of the causes of the pool's insufficiency, the assessments necessary to
				replenish it and the steps taken to prevent a recurrence of such
				circumstances.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-65 - Self-Insurance Pools For Political Subdivisions › Section 114-65-12 - Distribution of Surplus Funds

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1. Any
				surplus accumulated within a pool's fiscal year, as determined from the annual
				audited financial statement, may be declared refundable by the board. No
				distribution of the surplus funds shall be made earlier than twenty-four months
				following the end of the pool's fiscal year for which a surplus was declared. Such
				distribution shall not be made until certified by an actuary and the plan has been
				filed with and approved by the Commissioner.
12.2. Surplus accumulated within a pool's fiscal
				year shall be used exclusively for the benefit of those members belonging to the
				pool during that year. The accounting for each pool's fiscal year shall be separate
				for each year:
Provided,
That the Commissioner may require, and
				shall permit upon application of the pool, that 5.0%, or such greater amount as the
				board may elect, of a pool's surplus accumulated within a fiscal year be allocated
				to a restricted surplus account at the end of that year:
Provided,
				however.
That the restricted surplus is, subject to the approval of the
				Commissioner, to be used at the direction of the pool's board.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-66 - Mental Health Parity Cost Containment Measures Application And Annual Reporting Requirements › Section 114-66-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				procedural rule sets forth requirements which the Commissioner considers necessary
				to carry out Rates and Forms Division Reporting Requirements for rate and form
				filings.
1.2. Authority. -- W. Va. Code
				§§
									33-2-10 and
				33-16-3a.
1.3. Filing Date. -- July 29, 2003.
1.4. Effective Date. -- August 28, 2003.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-66 - Mental Health Parity Cost Containment Measures Application And Annual Reporting Requirements › Section 114-66-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1 The abstract form
				attached to this rule as Appendix A must be completed and filed with the Insurance
				Commissioner when filing for mental health parity cost containment measures or
				annual reporting requirements.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-66 - Mental Health Parity Cost Containment Measures Application And Annual Reporting Requirements › Appendix A - MENTAL HEALTH PARITY COST CONTAINMENT MEASURES APPLICATION AND ANNUAL REPORTING REQUIREMENT ABSTRACT

Current through Register Vol. XLI, No. 28, July 12, 2024
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West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-67 - Rate And Form Filing Abstracts › Section 114-67-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				procedural rule establishes requirements for information and data to be provided to
				the Insurance Commissioner with the filing of advertisements, rates, and forms for
				all types of insurance which are subject to prior approval.
1.2. Authority. -- W. Va. Code §
									33-2-10.
1.3. Filing Date. -- August 26, 2004.
1.4. Effective Date. -- September 25,
				2004.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-67 - Rate And Form Filing Abstracts › Section 114-67-2 - Filing Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Each
				filing shall include two copies of the cover letter explaining the nature and intent
				of the filing, the appropriate filing fee, the appropriate filing abstract(s), all
				relevant information supporting the filing, and a return envelope sufficient to
				accommodate the return copy of the cover letter or filing.