W. Va. Code R. § 114-36-3

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

Section 114-36-3 - Form and Content of Summary Document

3.1. Except with respect to a policy or contract to which subsection 3.6 applies, after October 8, 2009, no Member Insurer or its agent may deliver a Policy or Contract to a Policy or Contract Holder, unless the Summary Document as set forth in Appendix A is delivered to the Policy or Contract Holder prior to or at the time of delivery of the Policy or Contract. Provided, That for any policy or contract delivered between July 10, 2009 and October 7, 2009, the policy or contract holder shall be provided with a copy of the Summary Document prior to October 8, 2009.

3.2. The insurer or agent making the delivery of the Summary Document shall maintain a record of the delivery.

3.3. The Summary Document shall be printed on a separate sheet of paper. The Summary Document may not include the name and address of the Member Insurer issuing the Policy or Contract or the name and address of the agent who procured the Policy or Contract.

3.4. The Summary Document shall be identical to that prescribed by the Commissioner in Appendix A of this rule.

3.5 Delivery of the Summary Document set forth in Appendix A satisfies the requirements set forth in W. Va. Code § 33-26A-19(b) and (c).

3.6. Delivery of the Notice set forth in Appendix B shall be made with respect to any policy or contract that is fully excluded from coverage under the Guaranty Association Act because it is not guaranteed by the insurer or the risk is borne by the policy or contract holder, and such delivery satisfies the requirements set forth in W. Va. Code § 33-26A-19(d) with respect to any policy or contract delivered after October 7, 2009, to which such subsection applies: Provided, That for any policy or contract delivered between July 10 and October 7, 2009, the policy or contract holder shall be provided with a copy of the Notice prior to October 8, 2009.

3.7. Member Insurers and their agents that provide the following types of excluded coverages or services excluded from coverage under the West Virginia Life and Health Insurance Guaranty Act are not required to provide the Summary Document required by this rule to the contract or policy holders receiving the excluded coverages or services:

3.7.a. Any policy or contract of reinsurance, unless assumption certificates have been issued;

3.7.b. Any plan or program of an employer, association or similar entity to provide life, health or annuity benefits to its employees or members to the extent that the plan or program is self-funded or uninsured, including, but not limited to, benefits payable by an employer, association or similar entity under:

3.7.b.1. A multiple employer welfare arrangement as defined in section 514 of the Employee Retirement Income Security Act of 1974, as amended;

3.7.b.2. A minimum premium group insurance plan;

3.7.b.3. A stop-loss group insurance plan;

3.7.b.4. An administrative services only contract;

3.7.c. Any policy or contract issued in this state by a Member Insurer at a time when the member insurer was not licensed or did not have a certificate of authority to issue the policy or contract in West Virginia;

3.7.d. Any unallocated annuity contract issued to an employee benefit plan protected under the federal pension benefit guaranty corporation.

W. Va. Code R. § 114-36-3