reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-3 - Definitions

Current through July 13, 2024
(a) For purposes of this Rule:
(b) "Ambulatory review" means utilization
				review of health care services performed or provided in an outpatient
				setting.
(c) "Authorized
				representative" means:
(i) A person to whom a
				claimant has given express written consent to represent the claimant in an
				external review;
(ii) A person
				authorized by law to provide substituted consent for a claimant; or
(iii) A family member of the claimant or the
				claimant's treating health care professional only when the claimant is unable
				to provide consent.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-4 - Applicability and Scope

Current through July 13, 2024
(a) Except as provided in subsection (b),
				this Rule shall apply to all insurance carriers.
(b) The provisions of this Rule shall not
				apply to a policy or certificate that provides coverage for long-term care
				insurance, as defined by W. S. §
									
										26-38-103, or to a Medicare supplement policy
				of insurance, as defined by the commissioner by regulation, coverage under a
				plan through Medicare, Medicaid, or the federal employees health benefits
				program, any coverage issued under Chapter 55 of Title 10, U.S. Code and any
				coverage issued as supplement to that coverage, any coverage issued as
				supplemental to liability insurance, Wyoming Workers' Compensation or
				automobile medical-payment insurance.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-5 - Notice of Right to Review

Current through July 13, 2024
(a) An insurance carrier shall notify the
				claimant in writing of the claimant's right to request a review of any claim
				denied on the basis of not being medically necessary or on a similar basis. The
				notice shall include the appropriate statement and information set forth in
				subsection (b). The notice shall be sent to the claimant each time and at the
				same time as an insurance carrier sends written notice of the denial of claim
				on the basis of medical necessity or other similar basis.
(b) The notice of right to review shall
				include:
(i) Notice of the right to an
				internal review by the insurer which shall include:
(A) That the request for an internal review
				must be filed within thirty (30) days of the date the claimant received the
				denial of claim;
(B) That the
				claimant may submit additional information that relates to the claim;
(C) That the claimant may request the signed
				opinion of at least one (1) health care professional who is not an employee of
				the insurer;
(D) The procedure for
				filing the request for internal review; and
(E) That the claimant may have the right to
				an expedited review under circumstances where a delayed review would adversely
				affect the claimant.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-6 - Request for External Review

Current through July 13, 2024
(a) All requests for external review shall be
				made in writing to the insurer, on a form approved by the commissioner,
				together with a copy and fee of fifteen dollars ($15.00) payable by check or
				money order to the Wyoming State Treasurer. For any single claimant, there is
				an annual limit on fees of seventy-five dollars ($75.00) per calendar year.
(b) A claimant or the claimant's
				authorized representative may make a request for an external review of a denied
				claim or final denied claim.
(c) A
				claimant or the claimant's authorized representative may submit additional new
				information with the request for external review for consideration during the
				external review process.
(d) The
				request for external review shall be accompanied by a health care professional
				certification of medical necessity.
(e) The request for an expedited review shall
				be accompanied by a health care professional certification of need for
				expedited review.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-7 - Exhaustion of Internal Review Process

Current through July 13, 2024
(a) Except as provided in subsection (d), a
				request for an external review pursuant to Section 6 of this Rule shall not be
				made until the claimant has exhausted the insurer's internal review process
				required by W.S. §
									
										26-40-201(b)(iii).
(b) A claimant shall be considered to have
				exhausted the insurer's internal review process for purposes of this section,
				if the claimant or the claimant's authorized representative:
(i) Has filed a request for internal review
				involving a denied claim; and
(ii)
				Except to the extent the claimant or the claimant's authorized representative
				requested or agreed to a delay, has not received a written decision on the
				request for internal review from the insurer within forty five (45) days
				following the date the claimant or the claimant's authorized representative
				filed the request for internal review with the insurer.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-8 - Standard External Review

Current through July 13, 2024
(a) Within one hundred twenty (120) days
				after the date of receipt of a notice of a denial of claim pursuant to Section
				5 of this Rule, a claimant or the claimant's authorized representative may file
				a request for an external review with the insurer on a form approved by the
				commissioner.
(b) Within five (5)
				business days after the date of receipt of a request for external review
				pursuant to paragraph (a), the insurer shall send a copy of the request to the
				commissioner together with the fee.
(c) Within five (5) business days following
				the date of receipt of the external review request from the claimant, the
				insurer shall complete a preliminary review of the request to determine
				whether:
(i) The individual is or was a
				claimant in the insurance policy at the time the health care service was
				requested or, in the case of a retrospective review, was a claimant in the
				insurance policy at the time the health care service was provided;
(ii) The health care service that is the
				subject of the claim denial is a covered service under the claimant's insurance
				policy, but for a determination by the insurer that the health care service is
				not covered because it does not meet the requirements for medical necessity or
				other similar basis;
(iii) The
				claimant has exhausted the insurer's internal review process unless the
				claimant is not required to exhaust the insurer's internal review process
				pursuant to Section 7 of this Rule; and
(iv) The claimant has provided all the
				information, forms and fee required to process an external review, including
				the release form provided under Section 5(c) of this Rule.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-9 - Expedited External Review

Current through July 13, 2024
(a) A claimant or the claimant's authorized
				representative may make a request for an expedited external review with the
				commissioner at the time the claimant receives:
(i) A denial of claim if:
(A) The denied claim involves a medical
				condition of the claimant for which the timeframe for completion of an
				expedited internal review of a claim denial, if a standard external review
				would seriously jeopardize the life or health of the claimant or would
				jeopardize the claimant's ability to regain maximum function; or
(B) The claimant's claim concerns a request
				for an admission, availability of care, continued stay or health care service
				for which the claimant received emergency services, but has not been discharged
				from a health care facility; and
(C) The claimant or the claimant's authorized
				representative has filed a request for an expedited review of a claim denial as
				not being medically necessary or on a similar basis.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-10 - Binding Nature of External Review Decision

Current through July 13, 2024
(a) An external (or expedited) review
				decision is binding on the insurance carrier except to the extent the insurance
				carrier has other remedies available under applicable state law.
(b) An external review decision is binding on
				the claimant except to the extent the claimant has other remedies available
				under applicable federal or state law.
(c) A claimant or the claimant's authorized
				representative may not file a subsequent request for external review involving
				the same denied claim for which the claimant has already received an external
				review decision pursuant to W.S. §
									
										26-40-201.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-11 - Approval of Independent Review Organizations

Current through July 13, 2024
(a) The commissioner shall approve
				independent review organizations eligible to be assigned to conduct external
				reviews under W.S. §
									
										26-40-201.
(b) In order to be eligible for approval by
				the commissioner under this section to conduct external reviews an independent
				review organization:
(i) Shall be accredited
				by Utilization Review Accreditation Commission (URAC) or another nationally
				recognized private accrediting entity that the commissioner has determined has
				independent review organization accreditation standards that are equivalent to
				or exceed the minimum qualifications for independent review organizations
				established under Section 12 of this Rule; and
(ii) Shall submit an application for approval
				in accordance with subsection (c).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-12 - Minimum Qualifications for Independent Review Organizations

Current through July 13, 2024
(a) To be approved under Section 11 of this
				Rule to conduct external reviews, an independent review organization shall have
				and maintain written policies and procedures that govern all aspects of both
				the standard external review process and the expedited external review process
				set forth in this Rule that include, at a minimum:
(i) A quality assurance mechanism in place
				that:
(A) Ensures that external reviews are
				conducted within the specified time frames and required notices are provided in
				a timely manner;
(B) Ensures the
				selection of qualified and impartial clinical reviewers to conduct external
				reviews on behalf of the independent review organization and suitable matching
				of reviewers to specific cases and that the independent review organization
				employs or contracts with an adequate number of clinical reviewers to meet this
				objective;
(C) Ensures the
				confidentiality of medical and treatment records and clinical review criteria;
				and
(D) Ensures that any person
				employed by or under contract with the independent review organization adheres
				to the requirements of this Rule;
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-13 - Hold Harmless for Independent Review Organizations

Current through July 13, 2024
(a) No independent review organization or
				clinical reviewer working on behalf of an independent review organization or an
				employee, agent or contractor of an independent review organization shall be
				liable in damages to any person for any opinions rendered or acts or omissions
				performed within the scope of the organization's or person's duties under the
				law during or upon completion of an external review conducted pursuant to this
				Rule, unless the opinion was rendered or act or omission performed in bad faith
				or involved gross negligence.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-14 - External Review Reporting Requirements

Current through July 13, 2024
(a) An independent review organization
				assigned pursuant to Section 8 or
Section 9 of this Rule to conduct an external review shall
				  maintain written records grouped by assigning insurer on all Wyoming requests
				  for external review for which it conducted an external review during a calendar
				  year and, upon request, submit a report to the commissioner, as required under
				  paragraph (b) of this section.
(b) Each independent review organization
				required to maintain written records on all requests for external review
				pursuant to paragraph (a) of this section for which it was assigned to conduct
				an external review shall submit to the commissioner, upon request, a report in
				the format specified by the commissioner.
(c) The report shall include in the aggregate
				and for each insurance carrier:
(i) The total
				number of requests for external review;
(ii) The number of requests for external
				review resolved and, of those resolved, the number resolved upholding the
				denied claim or final denied claim and the number resolved reversing the denied
				claim or final denied claim;
(iii)
				The average length of time for resolution;
(iv) A summary of the types of coverages or
				cases for which an external review was sought, as provided in the format
				required by the commissioner;
(v)
				The number of external reviews pursuant to Section 8 of this Rule that were
				terminated as the result of a reconsideration by the insurer of its denied
				claim or final denied claim after the receipt of additional information from
				the claimant or the claimant's authorized representative; and
(vi) Any other information the commissioner
				may request or require.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-15 - Funding of External Review

Current through July 13, 2024
(a) The insurance carrier against which a
				request for a standard external review or an expedited external review is filed
				shall pay the cost of the independent review organization for conducting the
				external review.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-16 - Disclosure Requirements

Current through July 13, 2024
(a) Each insurance carrier shall include a
				description of the external review procedures in or attached to the policy,
				certificate, membership booklet, outline of coverage or other evidence of
				coverage it provides to claimants.
(b) The description required under subsection
				(a) shall include a statement that informs the claimant of the right of the
				claimant to file a request for an internal or external review in compliance
				with W.S. §
									
										26-40-201.
(c) In addition to subsection (b), the
				statement shall inform the claimant that, when filing a request for an external
				review, the claimant will be required to authorize the release of any medical
				records of the claimant that may be required to be reviewed for the purpose of
				reaching a decision on the external review.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-17 - Severability

Current through July 13, 2024
(a) If any provision of this Rule, or the
				application of the provision to any person or circumstance shall be held
				invalid, the remainder of the Rule, and the application of the provision to
				persons or circumstances other than those to which it is held invalid, shall
				not be affected.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 63 - MEDICAL NECESSITY REVIEW RIGHTS › Section 63-19

Current through July 13, 2024
Any violation of these regulations shall be enforceable
				  pursuant to the provisions of W.S. §
									
										26-1-107, W.S. §
									
										26-3-116, W.S. §
									
										26-9-211, and any other applicable rule or
				  statute.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-1 - Authority

Current through July 13, 2024
These regulations are promulgated pursuant to W.S.
				  §§
									16-3-101
et seq.,
26-2-110,
				  26-2-125 and
				  26-13-101
et
				  seq.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-2 - Scope and Purpose

Current through July 13, 2024
(a) This regulation applies to any sale or
				recommendation of an annuity.
(b)
				The purpose of this regulation is to require producers, as defined in this
				regulation, to act in the best interest of the consumer when making a
				recommendation of an annuity and to require insurers to establish and maintain
				a system to supervise recommendations so that the insurance needs and financial
				objectives of consumers at the time of the transaction are effectively
				addressed.
(c) Nothing herein shall
				be construed to create or imply a private cause of action for a violation of
				this regulation or to subject a producer to civil liability under the best
				interest standard of care outlined in Section
				5 of this regulation or under standards
				governing the conduct of a fiduciary or a fiduciary relationship.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-3 - Definitions

Current through July 13, 2024
(a) "Annuity," as set forth in W.S. §
									26-1-102(iv),
				means an annuity that is an insurance product that is individually solicited,
				whether the product is classified as an individual or group annuity.
(b) "Cash compensation" means any discount,
				concession, fee, service fee, commission, sales charge, loan, override, or cash
				benefit received by a producer in connection with the recommendation or sale of
				an annuity from an insurer, intermediary, or directly from the
				consumer.
(c) "Consumer profile
				information" means information that is reasonably appropriate to determine
				whether a recommendation addresses the consumer's financial situation,
				insurance needs and financial objectives, including, at a minimum, the
				following:
(i) Age;
(ii) Annual income;
(iii) Financial situations and needs,
				including debts and other obligations;
(iv) Financial experience;
(v) Insurance needs;
(vi) Financial objectives;
(vii) Intended use of the annuity;
(viii) Financial time horizon;
(ix) Existing assets or financial products,
				including investment, annuity and insurance holdings;
(x) Liquidity needs;
(xi) Liquid net worth;
(xii) Risk tolerance, including but not
				limited to, willingness to accept non-guaranteed elements in the
				annuity;
(xiii) Financial resources
				used to fund the annuity; and
(xiv)
				Tax status.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-4 - Exemptions

Current through July 13, 2024
Unless otherwise specifically included, this regulation shall
				  not apply to transactions involving:
(a) Direct response solicitations where there
				is no recommendation based on information collected from the consumer pursuant
				to this regulation;
(b) Contracts
				used to fund:
(i) An employee pension or
				welfare benefit plan that is covered by the Employee Retirement and Income
				Security Act (ERISA);
(ii) A plan
				described by sections
				401(a),
				401(k),
				403(b),
				408(k) or
				408(p) of the Internal
				Revenue Code (IRC), as amended, if established or maintained by an
				employer;
(iii) A government or
				church plan defined in section
				414 of the IRC, a government or church
				welfare benefit plan, or a deferred compensation plan of a state or local
				government or tax exempt organization under section
				457 of the IRC;
(iv) A nonqualified deferred compensation
				arrangement established or maintained by an employer or plan sponsor.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-5 - Duties of Insurers and Producers

Current through July 13, 2024
(a)
Best Interest Obligations.
A producer, when making a recommendation of an annuity, shall
				  act in the best interest of the consumer under the circumstances known at the
				  time of the recommendation is made, without placing the producer's or the
				  insurer's financial interest ahead of the consumer's interest. A producer has
				  acted in the best interest of the consumer if they have satisfied the following
				  obligations regarding care, disclosure, conflict of interest and
				  documentation:
(i) Care obligation.
(A) The producer, in making a recommendation
				shall exercise reasonable diligence, care and skill to:
(I) Know the consumer's financial situation,
				insurance needs and financial objectives;
(II) Understand the available recommendation
				options after making a reasonable inquiry into options available to the
				producer;
(III) Have a reasonable
				basis to believe the recommended option effectively addresses the consumer's
				financial situation, insurance needs and financial objectives over the life of
				the product, as evaluated in light of the consumer profile information;
				and
(IV) Communicate the basis or
				bases of the recommendation.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-6 - Producer Training

Current through July 13, 2024
(a) A producer shall not solicit the sale of
				an annuity product unless the producer has adequate knowledge of the product to
				recommend the annuity and the producer is in compliance with the insurer's
				standards for product training. A producer may rely on insurer-provided
				product-specific training standards and materials to comply with this
				section.
(b) One time training
				course.
(i) A producer who engages in the sale
				of annuity products shall:
(A) Complete a
				one-time four (4) credit training course approved by the department of
				insurance and provided by the department of insurance-approved education
				provider.
(B) Producers who hold a
				life insurance line of authority on the effective date of this regulation and
				who desire to sell annuities shall complete the requirements of this subsection
				within six (6) months after the effective date of this regulation. Individuals
				who obtain a life insurance line of authority on or after the effective date of
				this regulation may not engage in the sale of annuities until the annuity
				training course required under this subsection has been completed.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-7 - Compliance, Mitigation, Penalties, Enforcement

Current through July 13, 2024
(a) Failure to comply with the provisions of
				this Regulation is subject to the penalties identified in the insurance code,
				W.S. §
									26-1-101
et
				seq
.
(b) An insurer is
				responsible for compliance with this regulation. If a violation occurs, either
				because of the action or inaction of the insurer or its producer, the
				commissioner may order:
(i) An insurer to
				take reasonable appropriate corrective action for any consumer harmed by a
				failure to comply with this regulation by the insurer, an entity contracted to
				perform the insurer's supervisory duties or by the producer;
(ii) A general agency, independent agency or
				the producer to take reasonable appropriate corrective action for any consumer
				harmed by the producer's violation of this regulation; and
(iii) Appropriate penalties and
				sanctions.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 64 - REGULATION GOVERNING SUITABILITY IN ANNUITY TRANSACTIONS › Section 64-8 - Recordkeeping

Current through July 13, 2024
(a) Insurers, general agents, independent
				agencies and producers shall maintain or be able to make available to the
				commissioner records of the information collected from the consumer, disclosure
				made to the consumer, including summaries of oral disclosures, and other
				information used in making the recommendations that were the basis for
				insurance transactions for three (3) years after the insurance transaction is
				completed by the insurer. An insurer is permitted, but shall not be required,
				to maintain documentation on behalf of a producer.
(b) Records required to be maintained by this
				regulation may be maintained in paper, photographic, micro-process, magnetic,
				mechanical or electronic media or by any process that accurately reproduces the
				actual document.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-1 - Authority

Current through July 13, 2024
This regulation governing the sale of out-of-state health
				  insurance policies in the state of Wyoming supplements the provisions of
				  W.S.
				  26-18-301, et seq. This regulation is
				  promulgated by authority of and pursuant to the provisions in W.S.
				  W.S.
				  26-18-305 directing the Wyoming insurance
				  commissioner to adopt rules and regulations necessary for filing, approval, and
				  sale of health insurance policies that have been approved for sale in other
				  states, the Wyoming Administrative Procedure Act (W.S.
				  W.S.
				  16-3-101 through W.S.
				  W.S.
				  16-3-115 ) and the Wyoming Insurance Code
				  (W.S. W.S. 26-2-110 and W.S.
				  W.S.
				  26-2-125 ).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-2 - Purpose

Current through July 13, 2024
The purpose of this Regulation is:
(a) To establish standards for the sale of
				out-of-state health insurance policies, to develop a method of overseeing
				insurers selling out-of-state health insurance policies in Wyoming, and to
				protect the interests of Wyoming consumers who purchase out-of-state health
				insurance policies.
(b) To declare
				that failure to comply with the provisions of this regulation will be deemed an
				unfair method of competition and an unfair trade practice.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-3 - Scope

Current through July 13, 2024
This regulation shall apply to the sale of health insurance
				  policies including individual disability policies, small group disability
				  policies, or high deductible health policies approved for sale in other states
				  pursuant to
				  W.S.
				  26-18-301, et seq.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-4 - Definitions

Current through July 13, 2024
(a) As used in this regulation:
(i) Domicile state means the state that
				originally approved for sale the health insurance policies that the insurer
				intends to sell in Wyoming pursuant to W. S.
											26-18-301, et seq.
(ii) Essential community provider means a
				provider that serves predominantly low-income or medically underserved
				individuals.
(iii) Health insurance
				means individual disability policies, small group disability policies, or high
				deductible health policies as defined by W.S. §
										
											26-1-102(a)(xxxiii).
(iv) Out-of-state health insurance policy
				means a plan sold pursuant to W.S. §
										
											26-18-301, et seq. by a Wyoming licensed
				insurer that has been approved for sale in another state.
(v) Provider network means the facilities,
				providers, and supplier the insurer has contracted with to provide health care
				services.
(vi) SERFF means the
				system for electronic rate and form filing as developed and implemented by the
				National Association of Insurance Commissioners.
(vii) Wyoming mandated benefits means
				benefits required for individual and group plans including adult wellness
				benefits pursuant to W.S. §
										
											26-18-103(b) and W.S. §
										
											26-19-107(h); mandated
				coverage pursuant to W.S. §
										
											26-20-101, W.S. §
										
											26-20-201, W.S. §
										
											26-20-301, and W.S. §
										
											26-20-401; for group plans only, public
				health screenings pursuant to W.S. §
										
											26-19-107(j); and any other
				benefits mandated in Wyoming by statute after the date of adoption of this
				regulation.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-5 - Application

Current through July 13, 2024
(a) Application Contents. Prior to the sale
				of out-of-state health insurance policies in Wyoming, the insurer must file an
				application as prescribed by the Wyoming insurance commissioner and are subject
				to the applicable SERFF filing fees. The application must include at a minimum
				the following:
(i) Proof of current approval
				and product line authority in domicile state including health policy form
				number and date approved in the domicile state;
(ii) Proof of authorization to transact
				insurance in Wyoming;
(iii) The
				price of the health policy as sold in the domicile state and whether the health
				policy will be at the same price or at a Wyoming specific price;
(iv) A network provider directory that must,
				at a minimum, include providers specialties, locations of providers, acceptance
				of new patient status, the total unduplicated providers, and the total number
				of essential community providers in the provider network; and
(v) A description of the relationship between
				the insurer making the filing and the affiliate insurer, if any, which
				currently has approval for the issuance of health insurance policies in another
				state, the original state where the proposed product was approved, and the date
				of such approval.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-6 - Policy Requirements

Current through July 13, 2024
(a) Network
				Adequacy
(i) Pursuant to
				W.S.
				26-18-302(a)(vii), the
				Wyoming insurance commissioner shall review any provider network requirements
				in the out-of-state health insurance policy and may require modification of
				those requirements if the policy lacks sufficient network providers in
				Wyoming.
(ii) Provider networks are
				sufficient so long as:
(A) The insurer
				maintains a network that is sufficient in number and types of providers in
				Wyoming so as to assure that all services will be accessible without
				unreasonable delay as proven by submitting a network provider list to the
				Wyoming Department of Insurance; and
(B) The network has at least thirty percent
				(30%) of available essential community providers in the polices service area. A
				network that has at least five percent (5%) of available essential community
				providers in the polices service area may be considered sufficient so long as
				the insurer includes as part of its application a satisfactory narrative
				describing how the insurers provider network(s), as currently designed,
				provides an adequate level of service for low-income and medically underserved
				enrollees.
(iii) If the
				insurer has insufficient number or type of participating providers to provide a
				covered benefit, the insurer shall ensure that the covered person obtains the
				covered benefit at no greater cost to the covered person than if the benefit
				were obtained from participating providers, or shall make arrangements
				acceptable to the Wyoming insurance commissioner.
(iv) The insurer shall include a provider
				directory with the application form. The directory must at a minimum list
				providers specialties, locations of providers, acceptance of new patient
				status, the total unduplicated providers, and the total number of essential
				community providers in the provider network. The Wyoming insurance commissioner
				can require that more categories of disclosure be included in the provider
				directory. The Wyoming insurance commissioner may terminate the insurers
				ability to issue out-of-state health insurance policies in Wyoming should the
				network fail to meet the network adequacy standards set forth in this
				regulation.
(v) The insurer shall
				give the Wyoming insurance commissioner prompt notice of a potential loss of a
				material provider. Upon such notice the Wyoming insurance commissioner has the
				authority to initiate an interim network adequacy review.
(vi) Should the state of Wyoming adopt
				statutory standards for network adequacy for health insurance policies sold in
				Wyoming, those statutory provisions will preempt this regulatory guidance on
				network adequacy. Policies sold pursuant to W.S.
				W.S.
				26-18-301, et seq. will then be required to
				meet the statutory standards for network adequacy.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-7 - Reporting Requirements

Current through July 13, 2024
(a) All reporting
				requirements shall be submitted annually by March 1 every year through SERFF,
				and are subject to the applicable SERFF filing fees.
(b) Annual Network Report.
(i) An insurer shall file with the Wyoming
				Department of Insurance an updated network provider directory on an annual
				basis.
(ii) The directory at a
				minimum must list providers specialties, locations of providers, acceptance of
				new patient status, the total unduplicated providers, and the total number of
				essential community providers. If the network has under thirty percent (30%) of
				the essential community providers available in Wyoming, the insurer must give a
				narrative justification describing how the provider network(s) provides an
				adequate level of service for low-income and medically underserved
				enrollees.
(iii) The Wyoming
				insurance commissioner may terminate an insurers ability to issue out-of-state
				health insurance policies in Wyoming should the network not meet the network
				adequacy standards set forth in this regulation.
(iv) The Wyoming insurance commissioner may
				terminate an insurers ability to issue out-of-state health insurance policies
				in Wyoming should the insurer fail to file an annual network report pursuant to
				the Commissioners authority to establish network provider requirements as
				authorized under W.S. §
										
											26-18-302(a)(vii).
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 65 - REGULATION GOVERNING THE SALE OF OUT-OF-STATE HEALTH INSURANCE POLICIES › Section 65-8 - Separability

Current through July 13, 2024
If any provision of this rule or its application to any
				  person or circumstances is for any reason held to be invalid, the remainder of
				  the regulation and the application of its provisions to other persons or
				  circumstances shall not be affected.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-1 - Authority

Current through July 13, 2024
These regulations governing variable annuity contracts. They
				  are promulgated by the authority of and pursuant to the Wyoming Administrative
				  Procedure Act, W.S. §§
									
										16-3-101 through
				  16-3-115, and the Wyoming
				  Insurance Code, W.S. §§
									
										26-2-110,
				  26-9-217 and
				  26-16-502.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-2 - Definitions

Current through July 13, 2024
"Variable annuity," as used in this regulation shall mean any
				  policy or contract which provides for annuity benefits which may vary according
				  to the investment experience of any separate account or accounts maintained by
				  the insurer for such policy or contract.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-3 - Qualification of Insurance Companies To Issue Variable Annuities

Current through July 13, 2024
(a) A company shall not deliver or issue for
				delivery variable annuities within this state unless it is licensed or
				organized to do a life insurance or annuity business in this state and the
				commissioner is satisfied that its condition or method of operation in
				connection with the issuance of these contracts will not render its operation
				hazardous to the public or its policyholders. In this connection, the
				commissioner shall consider among other things:
(i) The history and financial condition of
				the company;
(ii) The character,
				responsibility and fitness of the officers and directors of the company;
				and
(iii) In the case of an insurer
				other than a domestic insurer, whether the statutes or regulations of the
				jurisdiction of its incorporation provide a degree of protection to
				policyholders and the public which is substantially equal to that provided by
				the Wyoming Insurance Code and such rules and regulations as are
				promulgated.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-4 - Separate Account

Current through July 13, 2024
(a) A domestic company issuing variable
				annuities shall establish one or more separate accounts pursuant to W.S. §
									
										26-16-502, subject to the following
				provisions:
(i) Except as may be provided
				with respect to reserves for guaranteed benefits and funds referred to in
				subsection (a)(ii):
(A) Amounts allocated to
				a separate account and its accumulations may be invested and reinvested without
				regard to any requirements or limitations prescribed by the laws of this state
				governing the investments of life insurance companies; and
(B) The investments in the separate account
				or accounts shall not be taken into account in applying the investment
				limitations otherwise applicable to the investments of the company.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-5 - Filing of Contracts

Current through July 13, 2024
The filing requirements applicable to variable annuities
				  shall be those filing requirements otherwise applicable under existing statutes
				  and regulations of this state with respect to individual and group life
				  insurance and annuity contract form filings, to the extent appropriate.
				  Contract form filings shall also include a certification by a member of the
				  American Academy of Actuaries as to the compliance with Section 7. In addition,
				  each insurer shall file with the Commissioner a copy of each prospectus adopted
				  by it for use in conjunction with the sale of any contract offered for sale in
				  this state.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-6 - Variable Annuity Contracts

Current through July 13, 2024
(a) A variable annuity providing benefits
				payable in variable amounts delivered or issued for delivery in this state
				shall contain a statement of the essential features of the procedures to be
				followed by the insurance company in determining the dollar amount of variable
				benefits. A contract, including a group contract and a certificate in evidence
				of variable benefits issued under the contract, shall state that the dollar
				amount will vary to reflect investment experience and shall contain on its
				first page a clear statement to the effect that the benefits of the contract
				are on a variable basis.
(b)
				Illustrations of benefits payable under any variable annuity shall not include
				projections of past investment experience into the future or attempted
				predictions of future investment experience. Nothing contained herein is
				intended to prohibit use of hypothetical assumed rates of return to illustrate
				possible levels of benefits.
(c) No
				individual variable annuity contract calling for the payment of periodic
				stipulated payments shall be delivered or issued for delivery in this state
				unless it contains in substance the following provision or provisions which in
				the opinion of the commissioner are more favorable to the holders of contracts:
(i) A provision that there shall be a grace
				period of thirty (30) days, within which any stipulated payment to the insurer
				falling due after the first may be made, during which grace period the contract
				shall continue in force. The contract may include a statement of the basis for
				determining the date as of which a payment received during the grace period
				shall be applied to produce the values arising under the contract;
				and
(ii) A provision that there
				shall be a reinstatement period in accordance with
				W.S.
				26-16-110.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-7 - Nonforfeiture Benefits

Current through July 13, 2024
(a) This section shall not apply to any:
(i) Reinsurance;
(ii) Group annuity contract purchases in
				connection with one or more retirement plans or plans of deferred compensation
				established or maintained by or for one or more employers (including
				partnerships or sole proprietorships), employee organizations, or any
				combination thereof, or other than plans providing individual retirement
				accounts or individual retirement annuities under Section 408 of the Internal
				Revenue Code, as now or hereafter amended;
(iii) Premium deposit fund;
(iv) Investment annuity;
(v) Immediate annuity;
(vi) Deferred annuity contract after annuity
				payments have commenced;
(vii)
				Reversionary annuity; or
(viii) To
				any contract which is to be delivered outside this state through an insurance
				producer or other representative of the company issuing the contract.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-8 - Required Reports

Current through July 13, 2024
(a) A company issuing individual variable
				annuities shall mail to the contractholder at least once in each contract year
				after the first at his or her last address known to the company, a statement or
				statements reporting the investments held in the separate account. The company
				shall submit annually to the insurance commissioner a statement of business of
				its separate account or accounts in such form as may be prescribed by the
				National Association of Insurance Commissioners.
(b) A company issuing individual variable
				annuities shall mail to the contractholder at least once in each contract year
				after the first at his or her last address known to the company a statement
				reporting as of a date not more than four (4) months previous to the date of
				mailing. In the case of an annuity contract under which payments have not yet
				commenced, the statement shall contain:
(i)
				The number of accumulation units credited to the contract and the dollar value
				of a unit; or
(ii) The value of the
				contractholder's account.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-9 - Foreign Companies

Current through July 13, 2024
If the law or regulation in the place of domicile of a
				  foreign company provides a degree of protection to the policyholders and the
				  public substantially equal to that provided by these regulations, the
				  commissioner, to the extent deemed appropriate by the commissioner, may
				  consider compliance with that law or regulation as compliance with these
				  regulations.
Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 66 - VARIABLE ANNUITY CONTRACT REGULATION › Section 66-10 - Qualifications of Insurance Producers for the Sale of Variable Annuities

Current through July 13, 2024
Any person selling or offering for sale a variable annuity
				  contract shall have a valid license under W.S. §
									
										26-9-206, authorizing the solicitation of
				  variable life and variable annuity products as defined in W.S. §
									
										26-9-207(a)(v), and shall
				  provide verification of required registration by the Financial Industry
				  Regulatory Authority (FINRA) and have successfully completed the Series 6 or
				  Series 7 and Series 63 examinations, or successfully completed the examination
				  for other applicable FINRA licenses.