W. Va. Code R. § 114-27-4

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

Section 114-27-4 - Medical/Lifestyle Applications Questions and Underwriting Guidelines

4.1. General Propositions:

a. No inquiry in an application for health accident and sickness or life insurance coverage, or in an investigation conducted by an insurer or an insurance support organization on its behalf in connection with an application for such coverage shall be directed toward determining the proposed insured's sexual orientation.

b. Sexual orientation may not be used in the underwriting process or in the determination of insurability.

c. Insurance support organizations shall be directed by insurers not to investigate, directly or indirectly, the sexual orientation of a proposed insured or beneficiary.

4.2. Medical/Lifestyle Applications Questions and Underwriting Standards.

a. No question shall be used which is designed to establish the sexual orientation of the proposed insured.

b. Questions relating to the proposed insured having or having been diagnosed as having AIDS or ARC are permissible if they are factual and designed to establish the existence of the condition.

For Example: Insurers should not ask "do you believe you may have . . .?", but rather "do you know or have reasons to know . . .?"

c. Questions inquiring as to whether the proposed insured has ever tested positive for the presence of the HIV virus or HIV virus antibodies are permissible; however, questions inquiring as to whether the proposed insured has ever been tested for the presence of the HIV virus or HIV antibodies are prohibited.

d. Questions relating to medical and other factual matters intending to reveal the possible existence of a medical condition are permissible if they are not used as a proxy to establish the sexual orientation of the proposed insured, and the proposed insured has been given an opportunity to provide an explanation for any affirmative answers given in the application.

For Example: "Have you had chronic cough, significant weight loss, chronic fatigue, diarrhea, enlarged glands, . . .?" would be permissible. These questions must relate to a definite time period immediately preceding the application and must be specific. The proposed insured shall be given the opportunity to explain the described symptoms.

e. Questions relating to the proposed insured's having or having been advised to seek treatment by a medical doctor, health nurse or other medical professional for a sexually transmitted disease are permissible.

f. Neither the marital status, the "living arrangements," the occupation, the gender, the medical history, the beneficiary designation, nor the zip code or other territorial classification of a proposed insured may be used to establish, or aid in establishing, the proposed insured's sexual orientation.

g. For purposes of rating a proposed insured for health and life insurance, an insurer may impose territorial rates, but only if the rates are based on sound actuarial principles and are related to actual or reasonably anticipated experience.

For Example: If a particular territory demonstrates a general propensity for high risk, an insurer may impose a rate higher for that territory than for similar risks located in other territories.

h. No questions shall seek to determine if the proposed insured has demonstrated AIDS-related concerns or has sought AIDS-related counseling.

i. No adverse underwriting decision shall be made because medical records or a report from an insurance support organization show(s) that the proposed insured has demonstrated AIDS-related concerns or has sought counseling. This subsection does not apply to a proposed insured seeking treatment and/or diagnosis.

W. Va. Code R. § 114-27-4