reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11D - Variable Life Insurance › Section 114-11D-4 - Insurance Policy Requirements

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Policy
				Qualification. The Commissioner may not approve any variable life insurance form
				filed pursuant to this rule unless it conforms to the requirements of this
				section.
4.2. Filing of Variable Life
				Insurance Policies. All variable life insurance policies, and all riders,
				endorsements, applications and other documents that are to be attached to be made a
				part of the policy and which relate to the variable nature of the policy, shall be
				filed with the Commissioner and approved by him or her prior to delivery or issuance
				for delivery in this state.
4.2.a. The procedures
				and requirements for filing and approval shall be, to the extent appropriate and not
				inconsistent with this rule, the same as those otherwise applicable to other life
				insurance policies.
4.2.b. The
				Commissioner may approve variable life insurance policies and related forms with
				provisions the Commissioner deems to be not less favorable to the policyholder and
				the beneficiary than those required by this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11D - Variable Life Insurance › Section 114-11D-6 - Separate Accounts

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The
				requirements of this section apply to the establishment and administration of
				variable life insurance separate accounts by a domestic insurer.
6.2. Establishment and Administration of Separate
				Accounts. A domestic insurer issuing variable life insurance shall establish one or
				more separate accounts pursuant to W. Va. Code §
									33-13A-1.
6.2.a. The insurer may not without prior written
				approval of the Commissioner employ in any material connection with the handling of
				separate account assets any person who:
6.2.a.1.
				Within the last ten (10) years has been convicted of any felony or a misdemeanor
				arising out of such person's conduct involving embezzlement, fraudulent conversion,
				or misappropriation of funds or securities or involving violation of Sections 1341,
				1342 or 1343 of Title 18, United States Code; or
6.2.a.2. Within the last ten (10) years has been
				found by any state regulatory authority to have violated or has acknowledged
				violation of any provision of any state insurance law involving fraud, deceit or
				knowing misrepresentation; or
6.2.a.3.
				Within the last ten (10) years has been found by federal or state regulatory
				authorities to have violated or has acknowledged violation of any provision of
				federal or state securities laws involving fraud, deceit or knowing
				misrepresentation.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11D - Variable Life Insurance › Section 114-11D-7 - Information Furnished to Applicants

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1.
				An insurer delivering or issuing for delivery in this state a variable life
				insurance policy shall deliver the following to the applicant for the policy, and
				obtain a written acknowledgment of receipt from the applicant coincident with or
				prior to the execution of the application. The requirements of this section shall be
				deemed to have been satisfied to the extent that a disclosure containing information
				required by this section is delivered, either in the form of a prospectus included
				in the requirements of the Securities Act of 1933 and which was declared effective
				by the Securities and Exchange Commission; or all information and reports required
				by the Employee Retirement Income Security Act of 1974 if the policies are exempted
				from the registration requirements of the Securities Act of 1933 pursuant to Section
				3(a)(2) thereof.
7.1.a. A summary explanation, in
				non-technical terms, of the principal features of the policy, including a
				description of the manner in which the variable benefits will reflect the investment
				experience of the separate account and the factors that affect the variation. The
				explanation shall include notices of the provision required by paragraph 5,
				subdivision a, subsection 4.4 and subdivision f, subsection 4.4 of this
				rule;
7.1.b. A statement of the
				investment policy of the separate account, including:
7.1.b.1. A description of the investment
				objectives intended for the separate account and the principal types of investments
				intended to be made; and
7.1.b.2. Any
				restrictions or limitations on the manner in which the operations of the separate
				account are intended to be conducted;
7.1.c. A statement of the net investment return of
				the separate account for each of the last ten (10) years or such lesser period as
				the separate account has been in existence;
7.1.d. A statement of the charges levied against
				the separate account during the previous year;
7.1.e. A summary of the method to be used in
				valuing assets held by the separate account;
7.1.f. A summary of the federal income tax aspects
				of the policy applicable to the insured, the policyholder and the beneficiary;
				and
7.1.g. Illustrations of benefits
				payable under the variable life insurance contract. The illustrations shall be
				prepared by the insurer and may not include projections of past investment
				experience into the future or attempted predictions of future investments
				experience, provided that nothing contained herein prohibits use of hypothetical
				assumed rates of return to illustrate possible levels of benefits if it is made
				clear that the assumed rates are hypothetical only.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11D - Variable Life Insurance › Section 114-11D-8 - Applications

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. The application for
				a variable life insurance policy shall contain:
8.1.a. A prominent statement that the death
				benefit may be variable or fixed under specified conditions;
8.1.b. A prominent statement that cash values may
				increase or decrease in accordance with the experience of the separate account
				(subject to any specified minimum guarantees); and
8.1.c. Questions designed to elicit information
				that enables the insurer to determine the suitability of variable life insurance for
				the applicant.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11D - Variable Life Insurance › Section 114-11D-10 - Foreign Companies

Current through Register Vol. XLI, No. 28, July 12, 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 that is
				  substantially similar to that provided by these rules, the Commissioner to the
				  extent deemed appropriate by the Commissioner in his or her discretion, may consider
				  compliance with such law or regulation as compliance with these
				  rules.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11E - Annuity Disclosure › Section 114-11E-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to provide standards for the disclosure of certain minimum
				information about annuity contracts to protect consumers and foster consumer
				education. The rule specifies the minimum information which must be disclosed, and
				the method for disclosing it, and the use and content of illustrations, if used, in
				connection with the sale of annuity contracts. The goal of this rule is to ensure
				that purchasers of annuity contracts understand certain basic features of annuity
				contracts. This rule is based on the National Association of Insurance
				Commissioners' "Annuity Disclosure Model Regulation" (Model 245), as amended in
				2011.
1.2. Authority. -- W. Va. Code
				§
									33-2-10.
1.3. Filing Date. -- April 24, 2015
1.4. Effective Date. -- July 23,
				2015
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11E - Annuity Disclosure › Section 114-11E-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. This rule applies
				to all group and individual annuity contracts and certificates except:
2.1.a. Immediate and deferred annuities that do
				not contain non-guaranteed elements;
2.1.b.
2.1.b.1.
				Annuities used to fund:
2.1.b.1.A. An employee
				pension plan which is covered by the Employee Retirement Income Security Act
				("ERISA");
2.1.b.1.B. A plan described
				by Sections 401(a), 401 (k) or 403(b) of the Internal Revenue Code, where the plan,
				for purposes of ERISA, is established or maintained by an employer;
2.1.b.1.C. A governmental or church plan defined
				in Section 414 or a deferred compensation plan of a state or local government or a
				tax exempt organization under Section 457 of the Internal Revenue Code; or
2.1.b.1.D. A non-qualified deferred compensation
				arrangement established or maintained by an employer or plan
				sponsor;
2.1.b.2.
				Notwithstanding paragraph 2.1.b.1, this rule shall apply to annuities used to fund a
				plan or arrangement that is funded solely by contributions an employee elects to
				make whether on a pre-tax or after-tax basis, and where the insurance company has
				been notified that plan participants may choose from among two (2) or more fixed
				annuity providers and there is a direct solicitation of an individual employee by a
				producer for the purchase of an annuity contract. As used in this subsection, direct
				solicitation may not include any meeting held by a producer solely for the purpose
				of educating or enrolling employees in the plan or arrangement;
2.1.c. Structured settlement annuities;
2.1.d. Charitable gift annuities;
2.1.e. Funding agreements;
2.1.f. Non-registered variable annuities issued
				exclusively to an accredited investor or qualified purchaser as those terms are
				defined by the Securities Act of 1933 ( 15 U.S.C. Section 77 a et seq.), the
				Investement Company Act of 1940 ( 15 U.S.C. Section 80a-1 et seq.), or the
				regulations promulgated under either of those acts, and offered for sale and sold in
				a transaction that is exempt from registration under the Securities Act of 1933 ( 15
				U.S.C. Section 77 a et seq.); and
2.1.g.
				Transactions involving variable annuities and other registered products in
				compliance with Securities and Exchange Commission (SEC) rules and Financial
				Industry Regulatory Authority (FINRA) rules relating to disclosures and
				illustrations;
2.1.g.1. Notwithstanding
				subdivision 2.1.g, the delivery of the Buyer's Guide is required in sales of
				variable annuities, and when appropriate, in sales of other registered
				products.
2.1.g.2. Nothing in this
				subsection shall limit the Commissioner's ability to enforce the provisions of this
				rule or to require additional disclosure.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11E - Annuity Disclosure › Section 114-11E-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. "Buyer's Guide"
				means:
3.1.a For sales of fixed or fixed indexed
				annuities, either the "2013 Buyer's Guide for Deferred Annuities" or the "2013
				Buyer's Guide for Deferred Annuities-Fixed," as adopted by and available from the
				National Association of Insurance Commissioners ("NAIC."); or
3.1.b. For sales of variable annuities, either the
				"2013 Buyer's Guide for Deferred Annuities" or the "2013 Buyers Guide for Deferred
				Annuities - Variable," as adopted by and available from the
				NAIC.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11E - Annuity Disclosure › Section 114-11E-4 - Standards for the Disclosure and Buyer's Guide

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
4.1.a. Where
				the application for an annuity contract is taken in a face-to-face meeting, the
				applicant shall at or before the time of application be given both the disclosure
				document described in subsection 4.2 and the Buyer's Guide, if any.
4.1.b. Where the application for an annuity
				contract is taken by means other than in a face-to-face meeting, the applicant shall
				be sent both the disclosure document and the Buyer's Guide no later than five (5)
				business days after the completed application is received by the insurer.
4.1.b.1. With respect to an application received
				as a result of a direct solicitation through the mail:
4.1.b.1.A. Providing a Buyer's Guide in a mailing
				inviting prospective applicants to apply for an annuity contract shall be deemed to
				satisfy the requirement that the Buyer's Guide be provided no later than five (5)
				business days after receipt of the application.
4.1.b.1.B. Providing a disclosure document in a
				mailing inviting a prospective applicant to apply for an annuity contract shall be
				deemed to satisfy the requirement that the disclosure document be provided no later
				than five (5) business days after receipt of the application.
4.1.b.2. With respect to an application received
				via the Internet:
4.1.b.2.A. Taking reasonable
				steps to make the Buyer's Guide available for viewing and printing on the insurer's
				website shall be deemed to satisfy the requirement that the Buyer's Guide be
				provided no later than five (5) business day of receipt of the
				application.
4.1.b.2.B. Taking
				reasonable steps to make the disclosure document available for viewing and printing
				on the insurer's website shall be deemed to satisfy the requirement that the
				disclosure document be provided no later than five (5) business days after receipt
				of the application.
4.1.b.3. 
				A solicitation for an annuity contract provided in other than a face-to-face meeting
				shall include a statement that the proposed applicant may contact the Commissioner
				for a free annuity Buyer's Guide. In lieu of the foregoing statement, an insurer may
				include a statement that the prospective applicant may contact the insurer for a
				free annuity Buyer's Guide.
4.1.c. Where the Buyer's Guide and disclosure
				document are not provided at or before the time of application, a free look period
				of no less than fifteen (15) days shall be provided for the applicant to return the
				annuity contract without penalty. This free look shall run concurrently with any
				other free look provided under state law or rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11E - Annuity Disclosure › Section 114-11E-5 - Standards for Annuity Illustrations

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1.
				An insurer or producer may elect to provide a consumer an illustration at any time,
				provided that the illustration is in compliance with this section and:
5.1.a. Clearly labeled as an
				illustration;
5.1.b. Includes a statement
				referring consumers to the disclosure document and Buyer's Guide provided to them at
				the time of purchase for additional information about their annuity; and
5.1.c. Is prepared by the insurer or third party
				using software that is authorized by the insurer prior to its use, provided that the
				insurer maintains a system of control over the use of
				illustrations.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11E - Annuity Disclosure › Section 114-11E-6 - Report to Contract Owners

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. For
				annuities in the payout period that include non-guaranteed elements, and for
				deferred annuities in the accumulation period, the insurer shall provide each
				contract owner with a report, at least annually, on the status of the contract that
				contains at least the following information:
6.1.a. The beginning and end date of the current
				report period;
6.1.b. The accumulation
				and cash surrender value, if any, at the end of the previous report period and at
				the end of the current report period;
6.1.c. The total amounts, if any, that have been
				credited, charged to the contract value or paid during the current report period;
				and
6.1.d. The amount of outstanding
				loans, if any, as of the end of the current report period.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-11E - Annuity Disclosure › Section 114-11E-7 - Penalties

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. In addition to any
				other penalties provided by the laws of this state, an insurer or producer that
				violates a requirement of this rule shall be guilty of a violation of W. Va. Code
				§
									33-11-1 et.
				seq.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Section 114-12-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this legislative rule is to provide reasonable standardization of
				coverage and simplification of terms and benefits of individual accident and
				sickness insurance policies; to facilitate public understanding and comparison of
				such policies and contracts; to eliminate provisions contained in such policies and
				contracts which may be misleading or confusing in connection with either their
				purchase or the settlement of claims; and to provide for full disclosure in the sale
				of such policies and contracts. This rule applies to all individual accident and
				sickness insurance policies and all individual subscriber contracts of hospital,
				medical, dental and health service corporations, health care corporations, fraternal
				benefit societies, and all individual enrollee agreements of health maintenance
				organizations delivered or issued for delivery in this State on and after the
				effective date of this rule, except that it does not apply to:
a. Individual policies or contracts issued
				pursuant to a conversion privilege under a policy or contract of group or individual
				insurance when the group or individual policy or contract includes provisions which
				are inconsistent with the requirements of this rule;
b. Credit accident and sickness insurance subject
				to WV 114 CSR 6 "Regulation of Credit Life Insurance and Credit Accident and
				Sickness Insurance;@
c. Medicare
				supplement insurance policies subject to WV 114 CSR 24 "Medicare Supplement
				Insurance;@
d. Long-term care insurance
				policies subject to WV 114 CSR 32 "Long-Term Care Insurance;@
e. Coverage under the West Virginia Public
				Employees Insurance Act (W. Va. Code ''5-16-1 et seq.);
f. Coverage under Medicare or Medicaid;
				and
g. Coverage under any automobile
				no-fault, workers' compensation, employer's liability, occupational disease or
				similar law.
The requirements contained in this rule are in addition to any
				  other applicable rules previously or subsequently promulgated.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Section 114-12-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule:
2.1. "Applicant" means a person who seeks to
				contract for insurance coverage.
2.2.
				"Certificate" means any certificate delivered or issued for delivery in this State
				under a policy subject to this rule.
2.3. "Commissioner" means the Insurance
				Commissioner of the State of West Virginia.
2.4. "Creditable coverage" means, with respect to
				an individual, coverage of the individual under any of the following:
a. A group health plan;
b. Accident and sickness insurance
				coverage;
c. Part A or Part B of Title
				XVIII of the Social Security Act [42 U.S.C. '301 et seq.];
d. Title XIX of the Social Security Act, other
				than coverage consisting solely of benefits under section 1928;
e. Chapter 55 [10 U.S.C. '1071 et seq.] of Title
				10 of the United States Code;
f. A
				medical care program of the Indian Health Service or of a tribal
				organization;
g. A state health benefits
				risk pool;
h. A health plan offered
				under Chapter 89 [5 U.S.C. '8901 et seq.] of Title 5 of the United States
				Code;
i. A public health plan (as
				defined in federal regulations); or
j. A
				health benefit plan under section 5(e) of the Peace Corps Act (
				22 U.S.C.
				2504(e) ).
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Section 114-12-3 - Policy Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Except as
				provided in this rule, no policy or certificate subject to this rule may be
				advertised, solicited, delivered or issued for delivery in this State unless the
				policy or certificate contains definitions or terms which conform to the
				requirements of this section.
3.2.
				"Accident,@ "accidental injury,@ or "accidental means" shall be defined to employ
				"result" language and shall not include words which establish an accidental means
				test or use words such as "external, violent, visible wounds" or similar words of
				description or characterization.
a. The definition
				may not be more restrictive than the following: "Injury or injuries, for which
				benefits are provided" means accidental bodily injury sustained by the insured
				person which is the direct result of an accident, independent of disease or bodily
				infirmity or any other cause, and occurs while the insurance coverage is in
				force.
b. The definition may provide
				that the term "injuries" excludes injuries for which benefits are provided or
				available under any motor vehicle no-fault, workers' compensation, employer's
				liability, occupational disease or similar law, unless prohibited by law.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Section 114-12-4 - Prohibited Policy Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. No policy may
				utilize an initial premium which is less than a pro rata portion of the applicable
				annual premium.
4.2. No policy may
				contain a provision establishing a probationary or waiting period during which no
				coverage is provided under the policy: Provided, That a policy may contain a
				probationary or waiting period not to exceed ninety (90) days for specified diseases
				or conditions. Accident policies may not contain probationary or waiting periods.
a. An insurer offering accident and sickness
				insurance coverage, other than excepted benefits, in the individual market may not,
				with respect to an eligible individual desiring to enroll in individual accident and
				sickness insurance coverage, impose any preexisting condition exclusion with respect
				to such coverage.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Section 114-12-6 - Required Disclosure Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Each policy or certificate subject to this rule shall include a renewal,
				continuation or nonrenewal provision. The language or specifications of the
				provision shall be consistent with the type of policy or certificate to be issued.
				The provision shall be appropriately captioned, shall appear on the first page of
				the policy or certificate, and shall clearly state the duration, where limited, of
				renewability and the duration of the term of coverage for which the policy or
				certificate is issued and for which it may be renewed.
6.2. Except for riders or endorsements by which
				the insurer effectuates a request made in writing by the policyholder or
				certificateholder, or exercises a specifically reserved right under the policy, all
				riders or endorsements added to a policy after date of issue or at reinstatement or
				renewal which reduce or eliminate benefits or coverage in the policy shall require
				signed acceptance by the policyholder or certificateholder, as appropriate. After
				date of policy issue, any rider or endorsement which increases benefits or coverage
				with concomitant increase in premium during the policy term shall be agreed to in
				writing signed by the policyholder or certificateholder, as appropriate, except if
				the increased coverage or benefits are required by law.
6.3. Where a separate additional premium is
				charged for benefits provided in connection with riders or endorsements, the premium
				charge shall be set forth in the policy.
6.4. A policy which provides for the payment of
				benefits based on standards described as "usual and customary,@ "reasonable and
				customary,@ or words of similar import, shall include a definition of such terms
				within both the policy and its accompanying outline of coverage.
6.5. Any provisions limiting or excluding coverage
				of preexisting conditions shall appear in a separate paragraph on the first page of
				the policy, which shall be labeled "Preexisting Condition Limitations," and shall be
				included in the outline of coverage.
a. An insurer
				offering accident and sickness insurance coverage, other than excepted benefits, in
				the individual market may not, with respect to an eligible individual desiring to
				enroll in accident and sickness insurance coverage, impose any preexisting condition
				exclusion with respect to such coverage.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Section 114-12-7 - Requirements for Replacement

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1.
				Application forms shall include a question designed to elicit information as to
				whether the policy to be issued is intended to replace any other accident and
				sickness insurance presently in force. A supplementary application or other form to
				be signed by the applicant containing such a question may be used.
7.2. Upon determining that a sale will involve
				replacement, an insurer, other than a direct response insurer, or its agent shall
				furnish the applicant, prior to issuance or delivery of the policy, the notice
				prescribed in appendix J of this rule. One (1) copy of the notice shall be retained
				by the insurer. A direct response insurer shall deliver to the applicant, upon
				issuance of the policy, the notice prescribed in appendix K of this rule. In no
				event, however, will a notice be required in the solicitation of accident-only and
				single-premium nonrenewable policies.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Section 114-12-8 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
If any provision of this legislative rule or the application
				  thereof to any person or circumstance is for any reason held to be invalid, the
				  remainder of the rule and the application of the provision to other persons or
				  circumstances shall not be affected.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix A

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
BASIC HOSPITAL EXPENSE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Basic Hospital Expense Coverage. -- Policies of this category
				  are designed to provide, to persons insured, coverage for hospital expenses incurred
				  as a result of a covered accident or sickness. Coverage is provided for daily
				  hospital room and board, miscellaneous hospital services and hospital outpatient
				  services, subject to any limitations, deductibles and copayment requirements set
				  forth in the policy. Coverage is not provided for physicians' or surgeons' fees or
				  unlimited hospital expenses. [Note: Final sentence may be appropriately modified, if
				  necessary, to reflect coverage provided].
(3) [A brief specific description of the benefits contained in
				  this policy, in the following order:
(a) Daily hospital room and board;
(b) Miscellaneous hospital services;
(c) Hospital outpatient services; and
(d) Other benefits, if any.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservation of right to
				  change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix B

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
BASIC MEDICAL-SURGICAL EXPENSE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Basic Medical-Surgical Expense Coverage. -- Policies of this
				  category are designed to provide, to persons insured, coverage for medical-surgical
				  expenses incurred as a result of a covered accident or sickness. Coverage is
				  provided for surgical services, anesthesia services and in-hospital medical
				  services, subject to any limitations, deductibles and copayment requirements set
				  forth in the policy. Coverage is not provided for hospital expenses or unlimited
				  medical-surgical expenses. [Note: Final sentence may be appropriately modified, if
				  necessary, to reflect coverage provided.]
(3) [A brief specific description of the benefits, including
				  dollar amounts and number of days' duration where applicable, contained in this
				  policy, in the following order:
(a) Surgical services;
(b) Anesthesia services;
(c) In-hospital medical services; and
(d) Other benefits, if any.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservation of right to
				  change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix C

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
BASIC HOSPITAL AND MEDICAL-SURGICAL EXPENSE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Basic Hospital and Medical-Surgical Expense Coverage. --
				  Policies of this category are designed to provide, to persons insured, coverage for
				  hospital and medical-surgical expenses incurred as a result of a covered accident or
				  sickness. Coverage is provided for daily hospital room and board, miscellaneous
				  hospital services, hospital outpatient services, surgical services, anesthesia
				  services and in-hospital medical services, subject to any limitations, deductibles
				  and copayment requirements set forth in the policy. Coverage is not provided for
				  unlimited hospital or medical-surgical expenses. [Note: Final sentence may be
				  appropriately modified, if necessary, to reflect coverage provided.]
(3) [A brief specific description of the benefits, including
				  dollar amounts and number of days' duration where applicable, contained in this
				  policy, in the following order:
(a) Daily hospital room and board;
(b) Miscellaneous hospital services;
(c) Hospital outpatient services;
(d) Surgical services;
(e) Anesthesia services;
(f) In-hospital medical services; and
(g) Other benefits, if any.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservation of right to
				  change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix D

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
HOSPITAL CONFINEMENT INDEMNITY COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Hospital Confinement Indemnity Coverage. -- Policies of this
				  category are designed to provide, to persons insured, coverage in the form of a
				  fixed daily benefit during periods of hospitalization resulting from a covered
				  accident or sickness, subject to any limitations, deductibles and copayment
				  requirements set forth in the policy. Such policies do not provide any benefits
				  other than the fixed daily indemnity for hospital confinement. [Note: Final sentence
				  may be appropriately modified to reflect additional benefits provided, if
				  any.]
(3) [A brief specific description of the benefits contained in
				  this policy, in the following order:
(a) Daily benefit payable during hospital confinement; and
(b) Duration of benefit described in (a) above.
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefit described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservation of right to
				  change premiums.]
(6) [Any benefits provided in addition to the daily hospital
				  confinement indemnity benefit.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix E

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
MAJOR MEDICAL EXPENSE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Major Medical Expense Coverage. -- Policies of this category
				  are designed to provide, to persons insured, coverage for major hospital, medical
				  and surgical expenses incurred as a result of a covered accident or sickness.
				  Coverage is provided for daily hospital room and board, miscellaneous hospital
				  services, surgical services, anesthesia services, in-hospital medical services,
				  out-of-hospital care and prosthetic appliances, subject to any limitations,
				  deductibles or copayment requirements set forth in the policy. Basic hospital or
				  basic medical insurance coverage is not provided. [Note: Final sentence may be
				  appropriately modified, if necessary, to reflect coverage provided.]
(3) [A brief specific description of the benefits, including
				  dollar amounts, contained in this policy, in the following order:
(a) Daily hospital room and board;
(b) Miscellaneous hospital services;
(c) Surgical services;
(d) Anesthesia services;
(e) In-hospital medical services;
(f) Out-of-hospital care;
(g) Prosthetic appliances;
(h) Maximum dollar amount for covered charges; and
(i) Other benefits, if any.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of any policy provisions respecting
				  renewability or continuation of coverage, including age restrictions or any
				  reservation of right to change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix F

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
DISABILITY INCOME PROTECTION COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Disability Income Protection Coverage. -- Policies of this
				  category are designed to provide, to persons insured, coverage for disabilities
				  resulting from a covered accident or sickness, subject to any limitations,
				  deductibles or copayment requirements set forth in the policy. Coverage is not
				  provided for basic hospital, basic medical-surgical or major-medical expenses.
				  [Note: Final sentence may be appropriately modified, if necessary, to reflect
				  coverage provided.]
(3) [A brief specific description of the benefits contained in
				  this policy.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservation of right to
				  change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix G

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
ACCIDENT-ONLY COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Accident-Only Coverage. -- Policies of this category are
				  designed to provide, to persons insured, coverage for certain losses resulting from
				  a covered accident
only
, subject to any limitations, deductibles or
				  copayment requirements set forth in the policy. Coverage is not provided for basic
				  hospital, basic medical-surgical or major-medical expenses. [Note: Final sentence
				  may be appropriately modified, if necessary, to reflect coverage provided.]
(3) [A brief specific description of the benefits contained in
				  this policy.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservation of right to
				  change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix H

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
[SPECIFIED DISEASE] [SPECIFIED ACCIDENT] COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) [Specified Disease] [Specified Accident] Coverage. -- Policies
				  of this category are designed to provide, to persons insured, restricted coverage
				  paying benefits
only
when certain losses occur as a result of
				  [specified diseases] [specified accidents], subject to any limitations, deductibles
				  or copayment requirements set forth in the policy. Coverage is not provided for
				  basic hospital, basic medical-surgical or major medical expenses. [Note: Final
				  sentence may be appropriately modified, if necessary, to reflect coverage
				  provided.]
(3) [A brief specific description of the benefits, including
				  dollar amounts, contained in this policy.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservation of right to
				  change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.
West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-12 - Individual Accident And Sickness Insurance Minimum Standards › Appendix I

Current through Register Vol. XLI, No. 28, July 12, 2024
[COMPANY NAME]
LIMITED BENEFITS HEALTH COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage
				  provides a very brief description of the important features of your policy. This is
				  not the insurance policy, and only the actual policy provisions will control. The
				  policy itself sets forth in detail the rights and obligations of both you and your
				  insurer. It is, therefore, important that you
Read Your Policy
				  Carefully!
(2) Limited Benefits Health Coverage. -- Policies of this category
				  are designed to provide, to persons insured, limited or supplemental insurance
				  coverage, subject to any limitations, deductibles or copayment requirements set
				  forth in the policy.
(3) [A brief specific description of the benefits, including
				  dollar amounts, contained in this policy.]
(4) [A description of any policy provisions which exclude,
				  eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify
				  payment of the benefits described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or
				  continuation of coverage, including age restrictions or any reservations of right to
				  change premiums.]
NOTE: In the outline of coverage forms that follow, only the
				  material appearing in brackets is to be composed by the insurer in language
				  appropriate for the coverage provided. All other material shall appear in exactly
				  the form set forth in this rule.