W. Va. Code R. § 114-17-1

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-17-1 - General

1.1. Scope. -- The purpose of this regulation is to establish certain minimum standards and provide reasonable standardization and simplification of terms and coverages for policies or subscriber contracts of accident and sickness insurance which are issued to persons eligible for Medicare by reason of age and which are designed to supplement Medicare or which are advertised, marketed or otherwise purported to be a supplement to Medicare, to eliminate provisions contained in any policy or contract sold to a person eligible for Medicare by reason of age which may be misleading or confusing, to establish certain loss ratio requirements and provide for full disclosure in the sale of such coverages.

(a) This regulation shall apply to:

(1) All individual Medicare Supplement or Limited Benefit Medicare Supplement policies and subscriber contracts delivered or issued for delivery in this State on or after the effective date hereof, and

(2) All certificates issued under group Medicare Supplement or Limited Benefit Medicare Supplement policies or subscriber contracts, which policies or contracts have been delivered or issued for delivery in this State, and

(3) Where applicable, all policies or contracts purporting to offer medical or surgical coverage which are delivered or issued for delivery in this State to persons eligible for Medicare by reason of age, including hospital confinement indemnity coverage, nursing home coverage and specified disease coverage sold to such persons.

(b) This regulation shall not apply to:

(1) A policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees, or combination thereof, or for members or former members, or combination thereof, of the labor organizations;

(2) A policy or contract of any professional, trade or occupational association for its members or former or retired members, or combination thereof, if such association is composed of individuals all of whom are actively engaged in the same profession, trade or occupation; has been maintained in good faith for purposes other than obtaining insurance; and has been in existence for at least two (2) years prior to the date of its initial offering of such policy or plan to its members;

(3) Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual insurance when such group or individual policy or contract includes provisions which are inconsistent with the requirements of this section; or

(4) Individual or group policies or contracts issued to employees or members as additions to franchise plans in existence on the effective date of this regulation.

(c) This regulation shall apply in conjunction with Series 12, Individual Accident and Sickness Insurance Minimum Standards, together with all other applicable laws and regulation.

1.2. Authority. -- W. Va. Code '33-2-10, '33-16-3d and '33-28-5b

1.3. Filing Date. -- November 12, 1981

1.4. Effective Date. -- December 28, 1981

W. Va. Code R. § 114-17-1