W. Va. Code R. § 114-28-1

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

Section 114-28-1 - General

1.1. Scope. -- This rule is applicable to every insurance contract which provides health care benefits and which is issued on or after January 21, 2011. Insurance contracts which provide health care benefits and which were issued before January 21, 2011 shall be brought into compliance by the later of the next anniversary date or renewal date of the contract or the expiration of any applicable collectively bargained contract pursuant to which it was written. This rule is based on the "Coordination of Benefits Model Regulation (Model 120)" adopted by the National Association of Insurance Commissioners, as amended in 2005.

1.2. Authority. -- W. Va. Code §§ 33-2-10,

1.3. Filing Date. -- April 14, 2010.

1.4. Effective Date. -- April 14, 2010.

1.5. Purpose. -- The purpose of this rule is to:

1.5.a. Establish a uniform order of benefit determination under which plans pay claims;

1.5.b. Reduce duplication of benefits by permitting a reduction of the benefits paid by a plan that, pursuant to this rule, does not have to pay its benefits first; and

1.5.c. Provide greater efficiency in the processing of claims when a person is covered under more than one plan.

W. Va. Code R. § 114-28-1